Dynamic changes in glymphatic function in reversible cerebral vasoconstriction syndrome
Abstract Background The pathophysiology of the reversible cerebral vasoconstriction syndrome (RCVS) remains enigmatic and the role of glymphatics in RCVS pathophysiology has not been evaluated. We aimed to investigate RCVS glymphatic dynamics and its clinical correlates. Methods We prospectively eva...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | The Journal of Headache and Pain |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s10194-024-01726-1 |
| _version_ | 1797273842790432768 |
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| author | Chia-Hung Wu Yu Kuo Yu-Hsiang Ling Yen-Feng Wang Jong-Ling Fuh Jiing-Feng Lirng Hsiu-Mei Wu Shuu-Jiun Wang Shih-Pin Chen |
| author_facet | Chia-Hung Wu Yu Kuo Yu-Hsiang Ling Yen-Feng Wang Jong-Ling Fuh Jiing-Feng Lirng Hsiu-Mei Wu Shuu-Jiun Wang Shih-Pin Chen |
| author_sort | Chia-Hung Wu |
| collection | DOAJ |
| description | Abstract Background The pathophysiology of the reversible cerebral vasoconstriction syndrome (RCVS) remains enigmatic and the role of glymphatics in RCVS pathophysiology has not been evaluated. We aimed to investigate RCVS glymphatic dynamics and its clinical correlates. Methods We prospectively evaluated the glymphatic function in RCVS patients, with RCVS subjects and healthy controls (HCs) recruited between August 2020 and November 2023, by calculating diffusion-tensor imaging along the perivascular space (DTI-ALPS) index under a 3-T MRI. Clinical and vascular (transcranial color-coded duplex sonography) investigations were conducted in RCVS subjects. RCVS participants were separated into acute (≤ 30 days) and remission (≥ 90 days) groups by disease onset to MRI interval. The time-trend, acute stage and longitudinal analyses of the DTI-ALPS index were conducted. Correlations between DTI-ALPS index and vascular and clinical parameters were performed. Bonferroni correction was applied to vascular investigations (q = 0.05/11). Results A total of 138 RCVS patients (mean age, 46.8 years ± 11.8; 128 women) and 42 HCs (mean age, 46.0 years ± 4.5; 35 women) were evaluated. Acute RCVS demonstrated lower DTI-ALPS index than HCs (p < 0.001) and remission RCVS (p < 0.001). A continuously increasing DTI-ALPS trend after disease onset was demonstrated. The DTI-ALPS was lower when the internal carotid arteries resistance index and six-item Headache Impact test scores were higher. In contrast, during 50–100 days after disease onset, the DTI-ALPS index was higher when the middle cerebral artery flow velocity was higher. Conclusions Glymphatic function in patients with RCVS exhibited a unique dynamic evolution that was temporally coupled to different vascular indices and headache-related disabilities along the disease course. These findings may provide novel insights into the complex interactions between glymphatic transport, vasomotor control and pain modulation. |
| first_indexed | 2024-03-07T14:50:00Z |
| format | Article |
| id | doaj.art-e064ca09c98f4940a532705b07fd2765 |
| institution | Directory Open Access Journal |
| issn | 1129-2377 |
| language | English |
| last_indexed | 2024-03-07T14:50:00Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | The Journal of Headache and Pain |
| spelling | doaj.art-e064ca09c98f4940a532705b07fd27652024-03-05T19:47:51ZengBMCThe Journal of Headache and Pain1129-23772024-02-0125111210.1186/s10194-024-01726-1Dynamic changes in glymphatic function in reversible cerebral vasoconstriction syndromeChia-Hung Wu0Yu Kuo1Yu-Hsiang Ling2Yen-Feng Wang3Jong-Ling Fuh4Jiing-Feng Lirng5Hsiu-Mei Wu6Shuu-Jiun Wang7Shih-Pin Chen8Department of Radiology, Taipei Veterans General HospitalDepartment of Radiology, Taipei Veterans General HospitalSchool of Medicine, National Yang Ming Chiao Tung UniversitySchool of Medicine, National Yang Ming Chiao Tung UniversitySchool of Medicine, National Yang Ming Chiao Tung UniversityDepartment of Radiology, Taipei Veterans General HospitalDepartment of Radiology, Taipei Veterans General HospitalSchool of Medicine, National Yang Ming Chiao Tung UniversitySchool of Medicine, National Yang Ming Chiao Tung UniversityAbstract Background The pathophysiology of the reversible cerebral vasoconstriction syndrome (RCVS) remains enigmatic and the role of glymphatics in RCVS pathophysiology has not been evaluated. We aimed to investigate RCVS glymphatic dynamics and its clinical correlates. Methods We prospectively evaluated the glymphatic function in RCVS patients, with RCVS subjects and healthy controls (HCs) recruited between August 2020 and November 2023, by calculating diffusion-tensor imaging along the perivascular space (DTI-ALPS) index under a 3-T MRI. Clinical and vascular (transcranial color-coded duplex sonography) investigations were conducted in RCVS subjects. RCVS participants were separated into acute (≤ 30 days) and remission (≥ 90 days) groups by disease onset to MRI interval. The time-trend, acute stage and longitudinal analyses of the DTI-ALPS index were conducted. Correlations between DTI-ALPS index and vascular and clinical parameters were performed. Bonferroni correction was applied to vascular investigations (q = 0.05/11). Results A total of 138 RCVS patients (mean age, 46.8 years ± 11.8; 128 women) and 42 HCs (mean age, 46.0 years ± 4.5; 35 women) were evaluated. Acute RCVS demonstrated lower DTI-ALPS index than HCs (p < 0.001) and remission RCVS (p < 0.001). A continuously increasing DTI-ALPS trend after disease onset was demonstrated. The DTI-ALPS was lower when the internal carotid arteries resistance index and six-item Headache Impact test scores were higher. In contrast, during 50–100 days after disease onset, the DTI-ALPS index was higher when the middle cerebral artery flow velocity was higher. Conclusions Glymphatic function in patients with RCVS exhibited a unique dynamic evolution that was temporally coupled to different vascular indices and headache-related disabilities along the disease course. These findings may provide novel insights into the complex interactions between glymphatic transport, vasomotor control and pain modulation.https://doi.org/10.1186/s10194-024-01726-1Reversible cerebral vasoconstriction syndrome (RCVS)Healthy controls (HCs)GlymphaticsTranscranial color-coded duplex sonography (TCCS)Diffusion-tensor imaging along the perivascular space (DTI-ALPS) indexThe six-item Headache Impact Test (HIT-6) |
| spellingShingle | Chia-Hung Wu Yu Kuo Yu-Hsiang Ling Yen-Feng Wang Jong-Ling Fuh Jiing-Feng Lirng Hsiu-Mei Wu Shuu-Jiun Wang Shih-Pin Chen Dynamic changes in glymphatic function in reversible cerebral vasoconstriction syndrome The Journal of Headache and Pain Reversible cerebral vasoconstriction syndrome (RCVS) Healthy controls (HCs) Glymphatics Transcranial color-coded duplex sonography (TCCS) Diffusion-tensor imaging along the perivascular space (DTI-ALPS) index The six-item Headache Impact Test (HIT-6) |
| title | Dynamic changes in glymphatic function in reversible cerebral vasoconstriction syndrome |
| title_full | Dynamic changes in glymphatic function in reversible cerebral vasoconstriction syndrome |
| title_fullStr | Dynamic changes in glymphatic function in reversible cerebral vasoconstriction syndrome |
| title_full_unstemmed | Dynamic changes in glymphatic function in reversible cerebral vasoconstriction syndrome |
| title_short | Dynamic changes in glymphatic function in reversible cerebral vasoconstriction syndrome |
| title_sort | dynamic changes in glymphatic function in reversible cerebral vasoconstriction syndrome |
| topic | Reversible cerebral vasoconstriction syndrome (RCVS) Healthy controls (HCs) Glymphatics Transcranial color-coded duplex sonography (TCCS) Diffusion-tensor imaging along the perivascular space (DTI-ALPS) index The six-item Headache Impact Test (HIT-6) |
| url | https://doi.org/10.1186/s10194-024-01726-1 |
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