All Central Nervous System Neuro- and Vascular-Communication Channels Are Surrounded With Cerebrospinal Fluid

Vascular Contribution to Cerebral Waste Clearance Affected by Aging or Diabetes

Background: The brain's vascular system has recently been shown to provide an important efflux pathway for cerebral waste clearance (CWC). However, little is known about the influence of aging or diabetes on the CWC. The aim of the current study is to investigate the vasculature contribution to CWC under aging and diabetic conditions. Methods: Male Wistar rats under aging and diabetic conditions were evaluated using dynamic intra-cisterna superparamagnetic iron oxide-enhanced susceptibility-weighted imaging (SPIO-SWI). Theoretical analysis of the expected signal intensity using SPIO-SWI was compared with the corresponding dynamic in vivo images. Quantitative susceptibility mapping (QSM) was used to evaluate the iron-based tracer concentration in the venous system. Results: Our data demonstrated that the theoretical analysis predicted the dynamic changes in the signal intensity after SPIO infusion. The distinct hyperintense signals due to the lower concentration of the SPIO over time in cerebrospinal fluid (CSF) and meningeal lymphatic (ML) vessels likely represented the CWC through various efflux pathways, including cerebral vascular and ML vessels. The QSM analysis further revealed reduced CWC from the vasculature in both the aged and diabetic groups compared to the younger group. Conclusions: Our results demonstrated that SPIO-SWI can quantitatively evaluate the CWC efflux contributions from cerebral vascular vessels under aging or diabetic conditions.

Sensitivity of Frequency Domain Near Infrared Spectroscopy for Neurovascular Structure Detection in Biotissue Volume: Numerical Modeling Results

Through numerical modeling, it has been determined that near infrared spectroscopy with a frequency domain approach can detect neurovascular structures with diameters from 0.5 mm at source-detector distances of 5-8 mm, depending on optical parameters and technical implementation of the method. Among the five classical machine learning methods considered, quadratic discriminant analysis is the most effective for detection. Furthermore, it has been demonstrated that the use of a photomultiplier tube and the registration of both amplitude and phase signal components exhibit the highest sensitivity. Spectroscopy can rival modern ultrasound for detecting arterial vessels. A cross-shaped probe configuration improves sensitivity, and the ratio of reduced scattering coefficient values at different wavelengths is informative for blood-filled vessel detection. These findings are consistent with and significantly extend previous experimental in vivo and in situ studies and could be valuable for intraoperative diagnostic tasks, particularly in neurosurgery.

Contribution of Direct Cerebral Vascular Transport in Brain Substance Clearance

The accumulation of harmful substances has long been recognized as a likely cause of many neurodegenerative diseases. The two classic brain clearance pathways are cerebrospinal fluid (CSF) and vascular circulation systems. Since the discovery of the glymphatic system, research on the CSF pathway has gained momentum, and impaired CSF clearance has been implicated in virtually all neurodegenerative animal models. However, the contribution of the direct participation of vascular transport across the blood-brain barrier in clearing substances is often ignored in glymphatic papers. Supportive evidence for the direct involvement of parenchymal vasculature in substance clearance is accumulated. First, multiple mechanisms have been proposed for the vascular drainage of exogenous and endogenous substances across the blood-brain barriers. Second, the "traditional" role of arachnoid villi and granulations as the main site for CSF draining into the vasculature system has been questioned. Third, MRI studies using different CSF tracers indicate that parenchymal vasculature directly participates in tracer efflux, consistent with immunohistochemical findings. Here we will review evidence in the literature that supports the direct participation of the parenchymal vascular system in substance clearance, in addition to the CSF clearance pathways.

Controls of Central and Peripheral Blood Pressure and Hemorrhagic/Hypovolemic Shock

The pressure exerted on the heart and blood vessels because of blood flow is considered an essential parameter for cardiovascular function. It determines sufficient blood perfusion, and transportation of nutrition, oxygen, and other essential factors to every organ. Pressure in the primary arteries near the heart and the brain is known as central blood pressure (CBP), while that in the peripheral arteries is known as peripheral blood pressure (PBP). Usually, CBP and PBP are correlated; however, various types of shocks and cardiovascular disorders interfere with their regulation and differently affect the blood flow in vital and accessory organs. Therefore, understanding blood pressure in normal and disease conditions is essential for managing shock-related cardiovascular implications and improving treatment outcomes. In this review, we have described the control systems (neural, hormonal, osmotic, and cellular) of blood pressure and their regulation in hemorrhagic/hypovolemic shock using centhaquine (Lyfaquin^®) as a resuscitative agent.

Impaired peri-olfactory cerebrospinal fluid clearance is associated with ageing, cognitive decline and dyssomnia

BACKGROUND

Animal experiments have demonstrated the dependency of cerebrospinal fluid clearance function on age and sleep, which partially underlay the cognitive decline in the elderly. However, human evidence is lacking, which could be mainly attributed to the limited methods of cerebrospinal fluid clearance function assessment.

METHOD

Serial T1-weighted and T2-fluid attenuated inversion recovery imaging were performed in 92 patients before and at multiple time points including 4.5 h, 15 h and 39 h after intrathecal injection of contrast agent to visualize the putative meningeal lymphatic pathway, peri-olfactory nerve pathway, and peri-optic nerve pathway. We defined the clearance function as the percentage change in signal unit ratio of critical locations in these pathways from baseline to 39 h after intrathecal injection, and further analysed their relationships with age, sleep, and cognitive function.

FINDINGS

Cerebrospinal fluid clearance through the putative meningeal lymphatic and perineural pathways were clearly visualized. The clearance function of putative meningeal lymphatic and perineural pathways were impaired with ageing (all P < 0.05). The clearance function through peri-olfactory nerve pathway in inferior turbinate was positively correlated with sleep quality and cognitive function (both P < 0.05), and mediated the association of sleep quality with cognitive function (percent change in β [bootstrap 95% CI]: 33% [-0.220, -0.007]).

INTERPRETATION

The impaired clearance through putative peri-olfactory nerve pathway may explain the cognitive decline in patients with sleep disturbance. The study shows a promising method to assess cerebrospinal fluid clearance function of putative peri-neural pathways via dynamic magnetic resonance imaging with intrathecal injection of contrast agent.

FUNDING

This work was supported by the National Natural Science Foundation of China (81971101, 82171276 and 82101365).

Hyperintense areas in the cisternal segments of the cranial nerves: a magnetic resonance imaging study

PURPOSE

The study aimed to explore hyperintense areas in the cisternal segments of the cranial nerves using magnetic resonance imaging (MRI).

METHODS

Seventy outpatients underwent thin-sliced, coronal constructive interference steady-state (CISS) sequence and sagittal T2-weighted MRI following conventional MRI examination.

RESULTS

With the coronal CISS sequence, hyperintense areas were located in the central parts of the olfactory bulbs in 65.7% of patients. For the intracranial optic nerve and optic chiasm, hyperintense areas were detected in 98.6% of the CISS sequences and 100% of the T2-weighted images. In the optic tract, hyperintense areas were detected in 51.4% of cases. In 35% of the patients who underwent the CISS sequence, the intracranial optic nerves were considerably compressed by the internal carotid and anterior cerebral arteries, with hyperintense areas similar to those in patients without vascular compression. Hyperintense areas of the cisternal segments of the oculomotor nerve and trigeminal root were identified in 52.9% and 87.1% of the patients, respectively.

CONCLUSIONS

The hyperintense areas found within the cisternal segments of the cranial nerves delineated on the coronal CISS sequence and sagittal T2-weighted imaging may indicate the intracranial part of the glymphatic pathway through the cranial nerves. The cranial nerves may function as part of the glymphatic pathway.

Waste Clearance in the Brain

Waste clearance (WC) is an essential process for brain homeostasis, which is required for the proper and healthy functioning of all cerebrovascular and parenchymal brain cells. This review features our current understanding of brain WC, both within and external to the brain parenchyma. We describe the interplay of the blood-brain barrier (BBB), interstitial fluid (ISF), and perivascular spaces within the brain parenchyma for brain WC directly into the blood and/or cerebrospinal fluid (CSF). We also discuss the relevant role of the CSF and its exit routes in mediating WC. Recent discoveries of the glymphatic system and meningeal lymphatic vessels, and their relevance to brain WC are highlighted. Controversies related to brain WC research and potential future directions are presented.