Cerebrospinal Fluid Transport: a Lymphatic Perspective

Johnston, Mary; Papaiconomou, Christina

doi:10.1152/nips.01400.2002

Cited by 71 publications

(74 citation statements)

References 15 publications

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“…The conventional view of CSF transport is that CSF is absorbed from the subarachnoid compartment through the arachnoid villi or granulations that project into the venous sinuses of the dura mater on the convexity of the brain. 3) The hydrostatic pressure difference between the CSF compartment and venous sinuses may be the driving force for absorption. 3) Cerebral venous hypertension resulting from direct arteriovenous shunting and/or obstruction of the sinuses may cause problems with the CSF dynamics.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Dural Arteriovenous Fistula Presenting as Typical Symptoms of Hydrocephalus Caused by Venous Congestion -Case Report-

Nakahara

Ogata

Takase

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 76-year-old woman presented with a dural arteriovenous fistula (DAVF) manifesting as typical symptoms of normal pressure hydrocephalus such as progressive dementia, gait disturbances, and urinary incontinence. The cerebrospinal fluid pressure during lumbar puncture was 120 mmH 2 O. Computed tomography and magnetic resonance imaging showed ventricular dilation and diffuse white matter changes, which were consistent with the symptoms of hydrocephalus. Cerebral angiography revealed a DAVF in the transverse-sigmoid sinuses with severe cortical venous reflux into the superior sagittal sinus. Transarterial embolization of the feeding arteries reduced the venous flow from the cortical veins into the superior sagittal sinus. Her symptoms improved with reduction in ventricle size. However, she suffered recurrence of the same symptoms several months later. Computed tomography and magnetic resonance imaging demonstrated ventricular dilation associated with hydrocephalus. Angiography revealed a fistulous channel in the left transverse-sigmoid junction. Transvenous embolization was performed resulting in complete obliteration of the fistula. Magnetic resonance image findings such as ventricular dilation and diffuse white matter disappeared and the symptoms of hydrocephalus improved. Although DAVFs often present as venous hypertensive encephalopathy, this case presented with ventricular dilation and diffuse white matter changes, which are the typical neurological signs of normalpressure hydrocephalus. Venous hypertension associated with the DAVF in the transverse-sigmoid sinuses may have been caused by normal pressure hydrocephalus.

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Section: Discussionmentioning

confidence: 99%

Treatment of Dural Arteriovenous Fistula Presenting as Typical Symptoms of Hydrocephalus Caused by Venous Congestion -Case Report-

Nakahara

Ogata

Takase

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…Also, spinal arachnoid villi along the nerve roots have been suggested as an absorption route for CSF (28). In animals, lymphatic drainage pathways have been shown to play an important role for CSF clearance (5,27,46). The existence of a lymphatic drainage pathway in humans remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…The arachnoid villi in the superior sagittal sinus have generally been thought to be the main site for CSF absorption in humans (2, 40). However, lymphatic drainage pathways have been shown in animal studies to play an important role for CSF clearance (5,27,46). The existence of this pathway in humans remains unclear.…”

mentioning

confidence: 99%

Spinal CSF absorption in healthy individuals

Edsbagge

Tisell

Jacobsson

et al. 2004

American Journal of Physiology-Regulatory, Integrative and Comp

140

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The present study examines the extent of spinal cerebrospinal fluid (CSF) absorption in healthy individuals in relation to physical activity, CSF production, intracranial pressure (ICP), and spinal CSF movement. Thirty-four healthy individuals aged 21-35 yr were examined by lumbar puncture and radionuclide cisternography with repeated imaging. ICP was registered before and after CSF drainage, and CSF production was calculated. Spinal CSF absorption was calculated as reduction in spinal radionuclide activity. The radionuclide activity in the spinal subarachnoidal space was gradually decreased by 20 Ϯ 13% (mean Ϯ SD) during 1 h. The reduction was higher in active than in resting individuals (27 Ϯ 12% vs. 13 Ϯ 9%). The mean ICP in 19 of the individuals was 13.6 Ϯ 3.1 cmH 2O. B-waves were found in 79% of the individuals, with a mean frequency of 0.6 Ϯ 0.3 min Ϫ1 . The mean CSF production rate was 0.34 Ϯ 0.13 ml/min. There were no correlations between radionuclide reduction, spinal movement of the radionuclide, and CSF production rate. The spinal radionuclide reduction found in this study indicates a spinal CSF absorption of 0.11-0.23 ml/min, more pronounced in active than in resting individuals. arachnoid villi; cerebrospinal fluid spinal flow; cerebrospinal fluid production; cerebrospinal fluid pressure; radionuclide imaging CEREBROSPINAL FLUID (CSF) is mainly produced in the choroid plexus in the lateral, third, and fourth ventricles, and a minor part is derived from the extracellular space of the brain (37). The CSF flows in a to-and-fro movement with a caudaldirected net flow through the aqueduct of Sylvius and foramina of Luschka and Magendie into the spinal subarachnoidal space (SAS) (39). The pulsative brain movements create a "mixing" of CSF in the fourth ventricle, basal cisterns, and upper spinal SAS (17, 23). Older radionuclide cisternographic (RC) studies have shown that radioactively labeled substances move upward when injected in the lumbar region (11) and downward when injected in the ventricles (12). Within the spinal SAS, a pulsatile to-and-fro flow with a caudal-directed net flow in the ventral and a cranial-directed net flow in the lateral cervical SAS has been reported (25, 42). However, the existence of a CSF bulk flow in any direction within the spinal SAS has been questioned, and RC and MRI observations could be explained by mere diffusion (22). The arachnoid villi in the superior sagittal sinus have generally been thought to be the main site for CSF absorption in humans (2, 40). However, lymphatic drainage pathways have been shown in animal studies to play an important role for CSF clearance (5,27,46). The existence of this pathway in humans remains unclear. Spinal CSF absorption through arachnoid granulations located along the nerve roots, morphologically similar to cranial villi, was suggested by Kido et al. (28), and CSF clearance from the spinal SAS has been demonstrated in sheep and cats (6, 31). The extent and importance of the spinal absorption pathway in humans remain unclear and, to ...

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“…This system contributes to clearance of small molecules and proteins from interstitial fluid to lymph nodes in the neck and spine, and Johnston and colleagues have shown that it accounts for a large fraction of CSF clearance. [103][104][105][106] Early studies established rapid distribution of tracers inserted into interstitial fluid or CSF throughout the entire brain via perivascular fluid, and rates of tracer delivery to lymph nodes varied with head position, intracranial pressure, arterial pulsations, and other factors. 107,108 Amyloid-beta, 14 C-metabolites of [ 14 C]glucose, and fluorescent tracers are cleared via this pathway by mechanisms involving astrocytic water movements mediated by aquaporins.…”

Section: Some Speculations: Hypoglycemic Glycogenolysis Mitochondriamentioning

confidence: 99%

Lactate Shuttling and Lactate use as Fuel after Traumatic Brain Injury: Metabolic Considerations

Dienel

2014

J Cereb Blood Flow Metab

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Lactate is proposed to be generated by astrocytes during glutamatergic neurotransmission and shuttled to neurons as 'preferred' oxidative fuel. However, a large body of evidence demonstrates that metabolic changes during activation of living brain disprove essential components of the astrocyte-neuron lactate shuttle model. For example, some glutamate is oxidized to generate ATP after its uptake into astrocytes and neuronal glucose phosphorylation rises during activation and provides pyruvate for oxidation. Extension of the notion that lactate is a preferential fuel into the traumatic brain injury (TBI) field has important clinical implications, and the concept must, therefore, be carefully evaluated before implementation into patient care. Microdialysis studies in TBI patients demonstrate that lactate and pyruvate levels and lactate/pyruvate ratios, along with other data, have important diagnostic value to distinguish between ischemia and mitochondrial dysfunction. Results show that lactate release from human brain to blood predominates over its uptake after TBI, and strong evidence for lactate metabolism is lacking; mitochondrial dysfunction may inhibit lactate oxidation. Claims that exogenous lactate infusion is energetically beneficial for TBI patients are not based on metabolic assays and data are incorrectly interpreted.

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Cerebrospinal Fluid Transport: a Lymphatic Perspective

Cited by 71 publications

References 15 publications

Treatment of Dural Arteriovenous Fistula Presenting as Typical Symptoms of Hydrocephalus Caused by Venous Congestion -Case Report-

Treatment of Dural Arteriovenous Fistula Presenting as Typical Symptoms of Hydrocephalus Caused by Venous Congestion -Case Report-

Spinal CSF absorption in healthy individuals

Lactate Shuttling and Lactate use as Fuel after Traumatic Brain Injury: Metabolic Considerations

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