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Abstract
The recent discoveries of the glymphatic and lymphatic systems of the brain have helped advance our understanding of CSF physiology and may allow new insights in the understanding of idiopathic intracranial hypertension (IIH). The clinical and radiologic presentations of IIH appear to be related to congestion of the glymphatic system associated with an overflow of the lymphatic CSF outflow pathway. By revisiting the role of “vascular arachnoid granulations” in the brain, we hypothesize that an initial impairment of the transport of interstitial fluid from the glymphatic system to the venous blood of the dural sinuses may trigger the hydrodynamic cascade of IIH. Furthermore, we speculate that, similar to other water-exchange systems in the brain, a specific subtype of aquaporin is involved in this transport. This theory may eventually help to provide an underlying explanation for IIH and its associated conditions, since in most of them, the expression of several aquaporins is altered.
Glossary
- AG=
- arachnoid granulation;
- AQP=
- aquaporin;
- CVP=
- cerebral venous pressure;
- ICP=
- intracranial pressure;
- IIH=
- idiopathic intracranial hypertension;
- ISF=
- interstitial fluid;
- TS=
- transverse sinus
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received January 26, 2018.
- Accepted in final form June 7, 2018.
- © 2018 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence
- Author response to Kronenberg et al.
- Author response to De Simone et al.
- Reader response: Idiopathic intracranial hypertension: The veno glymphatic connections
- Reader response: Idiopathic intracranial hypertension: The veno glymphatic connections
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