Case report: A multiple sclerosis patient with imaging features of glymphatic failure benefitted from CSF flow shunting

• Published in: Frontiers in neuroscience Vol. 16
• Main Authors: Scollato, Antonio, Lolli, Francesco, Lastrucci, Giancarlo, Repice, Anna, De Santis, Giuseppe, Nicoletti, Claudio, Porfirio, Berardino, Gallina, Pasquale
• Format: Journal Article
• Language: English
• Published: Lausanne Frontiers Research Foundation 01-11-2022; Frontiers Media S.A
• Subjects: Aquaporins; Case reports; Cerebrospinal fluid; Consent; CSF dynamic disturbances; CSF shunting; Fluid mechanics; Gait; glymphatic system; Hypotheses; Immune clearance; Immune response; Immunosurveillance; Lymphatic system; Magnetic resonance imaging; Multiple sclerosis; Neurodegeneration; Neuroimaging; Neuroscience; perivascular space
• ISSN: 1662-453X; 1662-4548; 1662-453X
• DOI: 10.3389/fnins.2022.863117

The derangement of CSF circulation impacts the functions of the glymphatic-lymphatic system (G-Ls), which regulates solute trafficking and immune surveillance in the CNS. The G-Ls failure leads to the dysregulation of clearance of waste molecules in the brain and to an altered CNS immune response. The imaging features of dilated perivascular spaces imply the impairment of the G-Ls. We report on the case of a patient with primary progressive multiple sclerosis and dilatation of perivascular spaces, who transiently improved after CSF shunt diversions. The underlying mechanisms remain to be determined and at this stage, it is not possible to link CSF diversion to an effect on MS pathology. However, this observation provides the rationale to incentivize research in the largely unknown area of CSF dynamic disturbances on G-Ls failure and ultimately in neurodegeneration.