Thrane Alexander S, Rangroo Thrane Vinita, Nedergaard Maiken
Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York 14642, USA; Department of Ophthalmology, Haukeland University Hospital, Bergen 5021, Norway; Letten Centre, Institute of Basic Medical Sciences, Department of Physiology, University of Oslo, 0317 Oslo, Norway.
Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York 14642, USA; Department of Ophthalmology, Haukeland University Hospital, Bergen 5021, Norway; Letten Centre, Institute of Basic Medical Sciences, Department of Physiology, University of Oslo, 0317 Oslo, Norway.
Trends Neurosci. 2014 Nov;37(11):620-8. doi: 10.1016/j.tins.2014.08.010. Epub 2014 Sep 15.
Edema formation frequently complicates brain infarction, tumors, and trauma. Despite the significant mortality of this condition, current treatment options are often ineffective or incompletely understood. Recent studies have revealed the existence of a brain-wide paravascular pathway for cerebrospinal (CSF) and interstitial fluid (ISF) exchange. The current review critically examines the contribution of this 'glymphatic' system to the main types of brain edema. We propose that in cytotoxic edema, energy depletion enhances glymphatic CSF influx, whilst suppressing ISF efflux. We also argue that paravascular inflammation or 'paravasculitis' plays a critical role in vasogenic edema. Finally, recent advances in diagnostic imaging of glymphatic function may hold the key to defining the edema profile of individual patients, and thus enable more targeted therapy.
水肿形成常常使脑梗死、肿瘤和创伤病情复杂化。尽管这种情况导致的死亡率很高，但目前的治疗方案往往效果不佳或尚未被完全理解。最近的研究揭示了存在一个全脑范围的用于脑脊液（CSF）和间质液（ISF）交换的血管旁途径。本综述批判性地研究了这个“类淋巴”系统对主要类型脑水肿的作用。我们提出，在细胞毒性水肿中，能量耗竭会增强类淋巴系统的脑脊液流入，同时抑制间质液流出。我们还认为血管旁炎症或“血管旁炎”在血管源性水肿中起关键作用。最后，类淋巴功能诊断成像的最新进展可能是确定个体患者水肿特征的关键，从而实现更有针对性的治疗。
