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Pseudotumor Cerebri and Glymphatic Dysfunction.

Marcio Luciano de Souza Bezerra1, Ana Carolina Andorinho de Freitas Ferreira2, Ricardo de Oliveira-Souza2

  • 1Rio Sono Clinic, Rio de Janeiro, Brazil.

Frontiers in Neurology
|February 2, 2018
PubMed
Summary

Glymphatic dysfunction, a problem with the brain's waste removal system, may cause idiopathic intracranial hypertension (IIH). This challenges previous ideas and suggests new treatment targets for IIH.

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Area of Science:

  • Neuroscience
  • Cerebrospinal Fluid Dynamics
  • Neuroimmunology

Background:

  • The central nervous system was long thought to lack a lymphatic system.
  • Recent discoveries reveal a glial-enclosed paravascular system facilitating cerebrospinal fluid (CSF) and interstitial fluid (IF) exchange.
  • Aquaporin-4 channels are critical for water transport in these brain compartments.

Purpose of the Study:

  • To hypothesize that glymphatic system dysfunction is a key factor in the development of idiopathic intracranial hypertension (IIH).
  • To propose that impaired glymphatic flow leads to interstitial fluid retention, causing IIH.
  • To explore the link between glymphatic dysfunction and IIH pathophysiology.

Main Methods:

  • Review of existing MRI studies showing IIH signs without CSF overproduction.
Keywords:
aquaporin-4cerebrospinal fluidglymphatic clearanceglymphatic systemidiopathic intracranial hypertensionparavascular spacespseudotumor cerebri

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  • Analysis of the relationship between glymphatic function, CSF-IF exchange, and IIH.
  • Consideration of supporting evidence including visual loss in IIH, obesity association, and glymphatic dysfunction in Alzheimer's disease.

    • Main Results:

    • MRI findings in IIH suggest impaired fluid dynamics rather than CSF overproduction.
    • Glymphatic dysfunction may arise from altered CSF flow into or IF outflow from the brain parenchyma.
    • Impaired optic nerve drainage, obesity, and Alzheimer's disease pathology support the glymphatic dysfunction hypothesis in IIH.

    Conclusions:

    • Glymphatic dysfunction offers a novel perspective on IIH pathophysiology.
    • This concept may guide the development of new therapies targeting CSF and glymphatic system flow.
    • Understanding glymphatic system roles is crucial for neurological disease research.