Interactions between Flow Oscillations and Biochemical Parameters in the Cerebrospinal Fluid

Abstract

The equilibrium between the ventricular and lumbar cerebrospinal fluid (CSF) compartments may be disturbed (in terms of flow and biochemistry) in patients with chronic hydrocephalus (CH). Using flow magnetic resonance imaging (MRI) and CSF assays, we sought to determine whether changes in CSF were associated with biochemical alterations. Nine elderly patients with CH underwent phase-contrast MRI. An index of CSF dynamics (Idyn) was defined as the product of the lumbar and ventricular CSF flows. During surgery, samples of CSF were collected from the lumbar and ventricular compartments and assayed for chloride, glucose and total protein. The lumbar/ventricular (L/V) ratio was calculated for each analyte. The ratio between measured and expected levels (Ibioch) was calculated for each analyte and compared with Idyn. Idyn varied from 0 to 100.103μl2.s2. In contrast to the L/V ratios for chloride and glucose, the L/V ratio for total protein varied markedly from one patient to another (mean ± standard deviation (SD): 2.63 ± 1.24). The Ibioch for total protein was strongly correlated with the corresponding Idyn (Spearman’s R: 0.98; p < 5 × 10−5).We observed correlated alterations in CSF flow and biochemical parameters in patients with CH. Our findings also highlight the value of dynamic flow analysis in the interpretation of data on CSF biochemistry.

Where are we? The anatomy of the murine cortical meninges revisited for intravital imaging, immunology, and clearance of waste from the brain

“…Thus, flow within the ventricles is not purely unidirectional away from the choroid plexuses. Perturbation of CSF flow, as in hydrocephalus, causes alterations in CSF composition, the concentration of protein in the ventricles (relative to that in lumbar CSF) tending to be higher (sic) in patients with greater CSF movements (Puy et al, 2016). 6.1.2.…”

“…7A) has two main components, a one synchronized with the cardiac cycle (Bergstrand et al, 1985;Barkhof et al, 1994;Schroth and Klose, 1992a;Knobloch et al, 2014), and another synchronized with respiration (Schroth and Klose, 1992b;Dreha-Kulaczewski et al, 2015Yildiz et al, 2017). In routine clinical PC-MRI of CSF velocity, the imaging is synchronized to the cardiac cycle and the instantaneous velocity, caudad during systole and rostrad during diastole, is plotted as a function of time: this gives useful diagnostic information on brain pathologies, particularly hydrocephalus (e.g., Nitz et al, 1992;Scollato et al, 2008;Penn et al, 2011;Puy et al, 2016) but not cognitive impairment (Luetmer et al, 2002). Net flux, if it exists, is much smaller than the to-and-fro fluxes and its calculation requires accurate determination of a zero reference velocity (Hladky and Barrand, 2014).…”

Characterization of intrathecal cerebrospinal fluid geometry and dynamics in cynomolgus monkeys (macaca fascicularis) by magnetic resonance imaging

“…Studies have examined the possible role of CSF as a conduit for distribution of radiolabeled tracers [15] and therapeutic molecules to neuronal and glial cells of CNS tissues [16,17]. Intrathecal delivery of these molecules directly to the CNS tissue [2] is, in part, dependent on pulsation-dependent mixing of the spinal CSF dynamics.…”

Decreased Cerebrospinal Fluid Flow Is Associated With Cognitive Deficit in Elderly Patients

“…The cerebrospinal fluid (CSF) is an important part of the central nervous system, as it allows exchange of water, small molecules and proteins between the brain parenchyma and arterial and venous blood (Oreskovic and Klarica, 2010; Brinker et al, 2014), by either passive diffusion or active transport (Oreskovic and Klarica, 2014; Oreskovic et al, 2017b). The CSF therefore plays an important role in regulating brain homeostasis, waste clearance (Puy et al, 2016), as well as intracranial pressure and blood supply (Baledent et al, 2004). During aging, CSF turnover can be disrupted (Rubenstein, 1998; Stoquart-ElSankari et al, 2007) which could contribute to the etiology of age-related neurocognitive disorders (Rubenstein, 1998; Weller et al, 2000; Launer, 2002; Silverberg et al, 2003; Chakravarty, 2004).…”