Brain edema is a severe stroke complication that is associated with prolonged hospitalization and poor outcomes. Swollen tissues in the brain compromise cerebral perfusion and may also result in transtentorial herniation. As a physical and biochemical barrier between the peripheral circulation and the central nervous system (CNS), the blood-brain barrier (BBB) plays a vital role in maintaining the stable microenvironment of the CNS. Under pathological conditions, such as ischemic stroke, the dysfunction of the BBB results in increased paracellular permeability, directly contributing to the extravasation of blood components into the brain and causing cerebral vasogenic edema. Recent studies have led to the discovery of the glymphatic system and meningeal lymphatic vessels, which provide a channel for cerebrospinal fluid (CSF) to enter the brain and drain to nearby lymph nodes and communicate with the peripheral immune system, modulating immune surveillance and brain responses. A deeper understanding of the function of the cerebral lymphatic system calls into question the known mechanisms of cerebral edema after stroke. In this review, we first discuss how BBB disruption after stroke can cause or contribute to cerebral edema from the perspective of molecular and cellular pathophysiology. Finally, we discuss how the cerebral lymphatic system participates in the formation of cerebral edema after stroke and summarize the pathophysiological process of cerebral edema formation after stroke from the two directions of the BBB and cerebral lymphatic system.

中文翻译：

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中风后脑水肿的形成：强调血脑屏障和大脑的淋巴引流系统。

脑水肿是一种严重的中风并发症，与住院时间延长和预后不良有关。脑组织肿胀会影响脑灌注，也可能导致小脑幕疝。作为外周循环和中枢神经系统（CNS）之间的物理和生化屏障，血脑屏障（BBB）在维持中枢神经系统微环境稳定方面起着至关重要的作用。在缺血性脑卒中等病理状态下，血脑屏障功能障碍导致细胞旁通透性增加，直接导致血液成分外渗至脑部，引起脑血管源性水肿。最近的研究导致发现了淋巴系统和脑膜淋巴管，它为脑脊液 (CSF) 进入大脑并排到附近的淋巴结提供了一个通道，并与外周免疫系统通信，调节免疫监视和大脑反应。对脑淋巴系统功能的更深入了解对中风后脑水肿的已知机制提出了质疑。在这篇综述中，我们首先从分子和细胞病理生理学的角度讨论中风后 BBB 破坏如何导致或促成脑水肿。最后，我们讨论脑淋巴系统如何参与脑卒中后脑水肿的形成，并从血脑屏障和脑淋巴系统两个方向总结脑卒中后脑水肿形成的病理生理过程。