Cerebrospinal fluid volume: the overlooked determinant in brain and spinal stroke

Emerging evidence suggests that reduced cerebrospinal fluid (CSF) volume may contribute to the onset and progression of both brain and spinal strokes. Traditionally under recognized, low CSF states can alter cerebral perfusion, compromise venous compliance, and exert mechanical strain on critical neural structures. This commentary integrates clinical observations, imaging findings, and biomechanical data to highlight the role of CSF depletion in stroke pathophysiology. Recognizing this mechanism may refine current models of cerebrovascular disease and inform novel strategies for prevention and management.