The Physiopathogenetic Basis for the Angiographic Diagnosis of Bacterial Infections of the Brain and Its Coverings in Children

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Abstract
Most of the small (50–60 µm) vessels nourish exclusively the cerebral cortex, whereas larger caliber (80–150 µm) arteries penetrate the entirety of the cortical layer to enter the underlying white matter. A single layer of nonfenestrated endothelial cells, surrounded by a continuous layer of basement membrane (which in places splits to envelope a pericyte), and perivascular glial cells attached to the outer surface of this basement membrane, with no pericapillary space, represent the anatomical structure of the blood-brain barrier (BBB). Concentrated electrolyte solutions and increases in mean arterial pressure may reopen the BBB. Water-soluble contrast media used in cerebral angiography are hypertonic solutions of iodinated salts. In cerebritis, one observes a very typical angiographic picture: ‘laminar’ staining of the gyri. The intervening sulci appear as negative images. In brain abscess, one may note angiographic evidence of a space-occupying lesion, a capsular stain in the granulation tissue surrounding the abscess, ‘halo’ formation and ‘pooling’ of contrast media in the sulci, and ‘laminar’ staining of the gyri.

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