The blood-brain barrier in trauma, stroke and edema

Successful research on human disease mechanisms and adequate pharmacotherapy depends on the availability of consistent and relevant animal models. For complex pathologies e.g. stroke and cerebral trauma it is highly important that the experimental models as much as possible mimic the pathogenesis and that drugs are delivered at the right time and the right place. Thereby it is not sufficient to counteract solely the endpoint of a traumatic or ischemic process i.e. irreversible neuronal cell death, but also to interfere with changes in other brain constituents e.g. the glial and endothelial compartments. Both are structural components of the blood-brain barrier and play a key role in the development of secondary phenomena as edema formation. The course and structural aspects of edema formation will be discussed, based on experience with several animal models of brain ischemia and trauma. It is concluded that stroke and trauma therapy is not only a matter of neurons and that acute treatment should focus on prevention of brain swelling.