From the Departments of Radiology (O.J., J.H., W.B.).
Neurology (J.C.-G., J.C., M.T.B.).
AJNR Am J Neuroradiol. 2021 Dec;42(12):2160-2164. doi: 10.3174/ajnr.A7326. Epub 2021 Nov 25.
Research suggests a connection between idiopathic intracranial hypertension and the cerebral glymphatic system. We hypothesized that visible dilated perivascular spaces, possible glymphatic pathways, would be more prevalent in patients with idiopathic intracranial hypertension. This prevalence could provide a biomarker and add evidence to the glymphatic connection in the pathogenesis of idiopathic intracranial hypertension.
We evaluated 36 adult (older than 21 years of age) patients with idiopathic intracranial hypertension and 19 controls, 21-69 years of age, who underwent a standardized MR imaging protocol that included high-resolution precontrast T2- and T1-weighted images. All patients had complete neuro-ophthalmic examinations for papilledema. The number of visible perivascular spaces was evaluated using a comprehensive 4-point qualitative rating scale, which graded the number of visible perivascular spaces in the centrum semiovale and basal ganglia; a 2-point scale was used for the midbrain. Readers were blinded to patient diagnoses. Continuous variables were compared using a Student test.
The mean number of visible perivascular spaces overall was greater in the idiopathic intracranial hypertension group than in controls (4.5 [SD, 1.9] versus 2.9 [SD, 1.9], respectively; = .004). This finding was significant for centrum semiovale idiopathic intracranial hypertension (2.3 [SD, 1.4] versus controls, 1.3 [SD, 1.1], = .003) and basal ganglia idiopathic intracranial hypertension (1.7 [SD, 0.6] versus controls, 1.2 [SD, 0.7], = .009). There was no significant difference in midbrain idiopathic intracranial hypertension (0.5 [SD, 0.5] versus controls, 0.4 [SD, 0.5], = .47).
Idiopathic intracranial hypertension is associated with an increased number of visible intracranial perivascular spaces. This finding provides insight into the pathophysiology of idiopathic intracranial hypertension, suggesting a possible relationship between idiopathic intracranial hypertension and glymphatic dysfunction and providing another useful biomarker for the disease.
研究表明特发性颅内高压与脑内糖质淋系统之间存在关联。我们假设特发性颅内高压患者中更常见可见的扩张性血管周围间隙，即可能的糖质淋途径。这种普遍性可能提供一种生物标志物，并为特发性颅内高压发病机制中的糖质淋联系提供更多证据。
我们评估了 36 例年龄大于 21 岁的特发性颅内高压成年患者（19 例为对照，年龄 21-69 岁），所有患者均行标准化磁共振成像检查，包括高分辨率对比前 T2 加权和 T1 加权成像。所有患者均行完整的神经眼科检查以评估视乳头水肿。使用全面的 4 分定性评分系统评估可见血管周围间隙的数量，对侧脑室和基底节的可见血管周围间隙数量进行评分；中脑采用 2 分评分系统。阅片者对患者的诊断情况不知情。使用学生 t 检验比较连续变量。
特发性颅内高压组的总体可见血管周围间隙数量多于对照组（4.5 [标准差，1.9]比 2.9 [标准差，1.9]；= 0.004）。这一发现对于侧脑室特发性颅内高压（2.3 [标准差，1.4]比对照组，1.3 [标准差，1.1]；= 0.003）和基底节特发性颅内高压（1.7 [标准差，0.6]比对照组，1.2 [标准差，0.7]；= 0.009）具有统计学意义。中脑特发性颅内高压无显著差异（0.5 [标准差，0.5]比对照组，0.4 [标准差，0.5]；= 0.47）。
特发性颅内高压与可见颅内血管周围间隙数量增加有关。这一发现深入了解了特发性颅内高压的病理生理学，提示特发性颅内高压与糖质淋功能障碍之间可能存在关联，并为该疾病提供了另一种有用的生物标志物。
