RESUMO
Pre-clinical research in rodents provides evidence that the central nervous system (CNS) has functional lymphatic vessels. In-vivo observations in humans, however, are not demonstrated. We here show data on CNS lymphatic drainage to cervical lymph nodes in-vivo by magnetic resonance imaging (MRI) enhanced with an intrathecal contrast agent as a cerebrospinal fluid (CSF) tracer. Standardized MRI of the intracranial compartment and the neck were acquired before and up to 24-48 hours following intrathecal contrast agent administration in 19 individuals. Contrast enhancement was radiologically confirmed by signal changes in CSF nearby inferior frontal gyrus, brain parenchyma of inferior frontal gyrus, parahippocampal gyrus, thalamus and pons, and parenchyma of cervical lymph node, and with sagittal sinus and neck muscle serving as reference tissue for cranial and neck MRI acquisitions, respectively. Time series of changes in signal intensity shows that contrast enhancement within CSF precedes glymphatic enhancement and peaks at 4-6 hours following intrathecal injection. Cervical lymph node enhancement coincides in time with peak glymphatic enhancement, with peak after 24 hours. Our findings provide in-vivo evidence of CSF tracer drainage to cervical lymph nodes in humans. The time course of lymph node enhancement coincided with brain glymphatic enhancement rather than with CSF enhancement.
Assuntos
Cistos Aracnóideos/diagnóstico por imagem , Sistema Glinfático/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Hipertensão Intracraniana/diagnóstico por imagem , Hipotensão Intracraniana/diagnóstico por imagem , Sistema Linfático/diagnóstico por imagem , Adulto , Idoso , Cistos Aracnóideos/líquido cefalorraquidiano , Cistos Aracnóideos/fisiopatologia , Estudos de Coortes , Meios de Contraste/administração & dosagem , Feminino , Sistema Glinfático/metabolismo , Sistema Glinfático/fisiopatologia , Humanos , Hidrocefalia/líquido cefalorraquidiano , Hidrocefalia/fisiopatologia , Injeções Espinhais , Hipertensão Intracraniana/líquido cefalorraquidiano , Hipertensão Intracraniana/fisiopatologia , Hipotensão Intracraniana/líquido cefalorraquidiano , Hipotensão Intracraniana/fisiopatologia , Linfonodos/diagnóstico por imagem , Linfonodos/metabolismo , Linfonodos/fisiopatologia , Sistema Linfático/metabolismo , Sistema Linfático/fisiopatologia , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/metabolismo , Vasos Linfáticos/fisiopatologia , Linfografia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , Giro Para-Hipocampal/diagnóstico por imagem , Giro Para-Hipocampal/metabolismo , Giro Para-Hipocampal/fisiopatologia , Tecido Parenquimatoso/diagnóstico por imagem , Tecido Parenquimatoso/metabolismo , Tecido Parenquimatoso/fisiopatologia , Ponte/diagnóstico por imagem , Ponte/metabolismo , Ponte/fisiopatologia , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/metabolismo , Córtex Pré-Frontal/fisiopatologia , Tálamo/diagnóstico por imagem , Tálamo/metabolismo , Tálamo/fisiopatologiaRESUMO
OBJECTIVE: The purpose of this study is to discuss the presentation, examination, diagnosis, and treatment of a case of intracranial hypotension presenting to a chiropractic office as acute severe headache and neck pain. CLINICAL FEATURES: Flexion injury during a weight lift resulted in a severe postural headache and upper cervical spine pain in a 51-year-old man. The patient presented with unusual symptoms, but normal palpatory findings, and a lack of postural distortion. INTERVENTION AND OUTCOME: Based on the history, symptoms, and examination findings, the patient was referred for an emergency medical evaluation. A diagnosis of intracranial hypotension was made, and a dural leak was confirmed by radioisotope cisternography. The patient made a complete recovery. CONCLUSIONS: Intracranial hypotension can cause headache and neck pain that may appear to be musculoskeletal in nature. The key symptom is the orthostatic nature of the headache.