The glymphatic system and subarachnoid hemorrhage: disruption and recovery

Quintin, Stephan; Barpujari, Arnav; Mehkri, Yusuf; Hernandez, Jairo; Lucke‐Wold, Brandon

doi:10.37349/ent.2022.00023

Cited by 10 publications

(8 citation statements)

References 89 publications

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“…It can be speculated whether impairment of the glymphatic system represents an additional pathophysiological basis for the development of aLPH. Meningeal lymphatic vessels have been shown to play a distinct role in patients suffering from SAH in a complex interaction of clearing erythrocytes from CSF to cervical lymph nodes, 24 re-entry of CSF, [25][26][27][28] and expression of aquaporin-4 at the blood-brain barrier and the blood-CSF interface, which is higher in patients suffering from SAH or IVH. [29][30][31][32][33] Sufficient CSF drainage potentially improves cerebral blood flow and normalizes the extracellular environment.…”

Section: Discussionmentioning

confidence: 99%

Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage

Czorlich¹,

Schweingruber

Göttsche³

et al. 2023

Neurosurgical Focus

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OBJECTIVE Acute and chronic hydrocephalus are common pathologies after aneurysmal subarachnoid hemorrhage (SAH). Generally, the presence of acute hydrocephalus is associated with elevated intracranial pressure (ICP) treated with a ventricular drain. Subsequently, however, pronounced hydrocephalus without elevated ICP may develop in some patients with SAH in the postacute phase. This is described as acute low-pressure hydrocephalus (aLPH), and there are very limited data in the literature of this pathology. The aim of this study was to evaluate the rate of and factors associated with aLPH and describe its clinical course. METHODS In this retrospective single-center cohort study, the frequency and clinical characteristics of SAH-associated aLPH were investigated. Acute LPH was defined as an increase in ventricular size as measured by the Evans index, ICP within the normal range (< 5 mm Hg) at the time of ventricular enlargement, and timely neurological improvement after indwelling ventricular CSF drainage with negative pressure up to 5 cm H2O below normal level. Demographic and SAH-specific factors in patients with SAH treated using an external ventricular drain were extracted from the electronic medical chart and further analyzed. RESULTS From November 2010 to May 2020, 15 (3.7.%) of 406 patients with SAH fulfilled the criteria for aLPH. Acute LPH was diagnosed after an average of 13.1 ± 7.7 days. The presence of IVH and its extension were associated with the occurrence of aLPH. After undergoing the transient phase of aLPH, these patients subsequently developed a chronic, typical malresorptive hydrocephalus requiring a ventriculoperitoneal shunt more often (66.7% vs 17.4%, p < 0.001) and stayed longer in the intensive care unit (27 vs 20.5 days, p = 0.043) and in the hospital (36.4 vs 26.3 days, p = 0.004). CONCLUSIONS Acute LPH is a rare pathology in patients with SAH and negatively impacts the clinical course. It should be especially considered in patients with a lack of neurological improvement, an increase in ventricular width, and normal ICP values, so that forced CSF drainage is implemented.

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Section: Discussionmentioning

confidence: 99%

Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage

Czorlich¹,

Schweingruber

Göttsche³

et al. 2023

Neurosurgical Focus

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“…The secondary brain edema induced by glymphatic retention was supported by the findings in subarachnoid hemorrhage (SAH) and high-altitude cerebral edema. Following SAH and hypoxic injury, blood components coagulation and cerebral vasodilation result in perivascular occlusion, which impairs CSF-ISF drainage ( 38 , 39 ). Based on these findings, we deduced that the adverse effects induced by hypothermia could be improved by increasing glymphatic drainage.…”

Section: Discussionmentioning

confidence: 99%

Hypothermia reduces glymphatic transportation in traumatic edematous brain assessed by intrathecal dynamic contrast-enhanced MRI

Bai

Yuan²,

Mi³

et al. 2022

Front. Neurol.

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The glymphatic system has recently been shown to clear brain extracellular solutes and can be extensively impaired after traumatic brain injury (TBI). Despite hypothermia being identified as a protective method for the injured brain via minimizing the formation of edema in the animal study, little is known about how hypothermia affects the glymphatic system following TBI. We use dynamic contrast-enhanced MRI (DCE-MRI) following cisterna magna infusion with a low molecular weight contrast agent to track glymphatic transport in male Sprague–Dawley rats following TBI with hypothermia treatment and use diffusion-weighted imaging (DWI) sequence to identify edema after TBI, and further distinguish between vasogenic and cytotoxic edema. We found that hypothermia could attenuate brain edema, as demonstrated by smaller injured lesions and less vasogenic edema in most brain subregions. However, in contrast to reducing cerebral edema, hypothermia exacerbated the reduction of efficiency of glymphatic transportation after TBI. This deterioration of glymphatic drainage was present brain-wide and showed hemispherical asymmetry and regional heterogeneity across the brain, associated with vasogenic edema. Moreover, our data show that glymphatic transport reduction and vasogenic edema are closely related to reducing perivascular aquaporin-4 (AQP4) expression. The suppression of glymphatic transportation might eliminate the benefits of brain edema reduction induced by hypothermia and provide an alternative pathophysiological factor indicating injury to the brain after TBI. Thus, this study poses a novel emphasis on the potential role of hypothermia in managing severe TBI.

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“…These waste products build up, as well as more ISF in the brain, as a result of glymphatic system disruption. The brain injury that results from the rupture of a significant blood artery is exacerbated by these occurrences, which are also present before and after subarachnoid bleeding (36) , (37) , (38) .…”

Section: Mechanismmentioning

confidence: 99%

Phenomenon of Hematocephalus: A Comprehensive Review of the Literature

2023

JMA J

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The phenomenon of hematocephalus is still not fully understood. Intraventricular hemorrhage volume and intracranial pressure play a substantial role in the outcome and survival of the patients. The intraventricular hemorrhage resulting in an increased intracranial pressure is known by the term “hematocephalus.” The mortality rate ranges from 60% to 91% when hemorrhage affects all four ventricles. Even for partial hematocephalus, the mortality rate has been reported to be 32% to 44%. Therefore, the main objective in managing hematocephalus is to remove intraventricular blood efficiently and quickly because doing so will reduce ventricular dilatation and will rebalance cerebrospinal fluid circulation. However, the current standard management, which is inserting a ventricular drain immediately after an intraventricular hemorrhage, appeared to be of little value as the catheters are invariably clogged with blood clots. Long-term outcomes from the external ventricular drainage insertion plus subsequent intraventricular fibrinolytic therapy have been encouraging, but it also carries a substantial risk of new intracranial bleeding. The neuroendoscopic approach was created to aid in the treatment of hematocephalus and to enable the hematoma to be reduced or removed quickly without invasive surgery or the administration of fibrinolytic medications, preventing the intraventricular inflammatory reactions that result from hematoma degradation products. A controlled trial is necessary to ascertain whether this procedure enhances patient outcomes when compared to ventricular draining with or without thrombolysis.

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The glymphatic system and subarachnoid hemorrhage: disruption and recovery

Cited by 10 publications

References 89 publications

Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage

Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage

Hypothermia reduces glymphatic transportation in traumatic edematous brain assessed by intrathecal dynamic contrast-enhanced MRI

Phenomenon of Hematocephalus: A Comprehensive Review of the Literature

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