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When blood hits the brain: altered glymphatic and dural lymphatic function after surface bleeds
Per Kristian Eide1,2,3, Markus Hovd4,5,6, Lars Magnus Valnes7,8
1Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. p.k.eide@medisin.uio.no.
Acute subdural hematoma (aSDH) and subarachnoid hemorrhage (SAH) differentially impact brain clearance pathways. aSDH showed modest glymphatic changes but reduced cerebrospinal fluid (CSF) clearance, while SAH severely impaired glymphatic function.
Area of Science:
- Neuroscience
- Cerebrospinal Fluid Dynamics
- Brain Imaging
Background:
- The impact of acute subdural hematoma (aSDH) on glymphatic and meningeal lymphatic function is unknown.
- This study investigates differential effects of surface intracranial bleeds on brain clearance.
Purpose of the Study:
- To explore the effects of acute subdural hematoma (aSDH) and subarachnoid hemorrhage (SAH) on glymphatic and dural lymphatic functions.
- To compare these effects using a cerebrospinal fluid (CSF) tracer in a small case series.
Main Methods:
- Used intrathecal gadobutrol as a CSF tracer with multiphase contrast-enhanced MRI.
- Assessed glymphatic tracer enrichment and CSF clearance to blood (dural lymphatic function proxy).
- Compared affected and unaffected hemispheres in unilateral bleed cases.
Main Results:
- One aSDH case showed slightly increased glymphatic enrichment but reduced CSF clearance compared to controls.
- Three SAH cases exhibited markedly reduced glymphatic enrichment on the affected side.
- Control subjects displayed symmetrical tracer distribution.
Conclusions:
- aSDH and SAH appear to differentially affect glymphatic and dural lymphatic functions.
- aSDH may compromise dural lymphatic drainage, while SAH severely impairs glymphatic function.
- Findings are hypothesis-generating for future studies on intracranial hemorrhages and brain clearance.
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