A Multiple Sclerosis Patient Benefitting from CSF Flow Enhancement Had Imaging Signs of "Glymphatic-Lymphatic System Disease." Case Report

Background The derangement of CSF circulation impacts the functions of glymphatic-lymphatic system (G-Ls), which regulates solute trafficking and immune surveillance in the CNS. The imaging features of dilated perivascular spaces imply the substantial impairment of the G-Ls and can be easily estimated It has been proposed that multiple sclerosis can be viewed as a disease involving a failure component and therapeutically could be targeted as such.Case presentationWe report the case of a female patient diagnosed with primary progressive multiple sclerosis, also presenting perivascular spaces dilatation, who transiently improved after CSF shunt diversions. ConclusionsThe G-Ls failure leads to dysregulation of waste molecule clearance in the brain and an altered CNS immune response, potentially in many diseases. The clinical improvement observed in our patient may relate to an increased clearance of inflammatory mediators following the G-Ls reestablishment obtained by CSF flow enhancement.

Deep vascular imaging in the eye with flow-enhanced ultrasound

The eye's retina is one of the most energy-demanding tissues in the body and thus requires high rates of oxygen delivery from a rich blood supply. The capillary lamina of the choroid lines the outer surface of the retina and is the dominating source of oxygen in most vertebrates, but this vascular bed is challenging to image with traditional optical techniques due to its position behind the highly light-absorbing retina. Here we describe a high-frequency ultrasound technique with flow-enhancement to image deep vascular beds (0.5 - 3 cm) of the eye with a high spatiotemporal resolution. This non-invasive method works well in species with nucleated red blood cells (non-mammalian and fetal animal models), and it generates non-invasive three-dimensional angiographies without the use of contrast agents that is independent of blood flow angles and with a higher sensitivity than Doppler based ultrasound imaging techniques.