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Bulat-Klarica-Oreskovic Hypothesis: A Comprehensive Review

Classical theories of cerebrospinal fluid (CSF) production and flow are taught throughout medical education. The idea that CSF is produced and/or filtered by the choroid plexus and flows in one direction throughout the ventricular system has been a largely accepted thesis. However, modern studies ha...

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Detalles Bibliográficos
Autores principales: Bajda, Joe, Pitla, Neharaj, Gorantla, Vasavi Rakesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10593140/
https://www.ncbi.nlm.nih.gov/pubmed/37876400
http://dx.doi.org/10.7759/cureus.45821
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author Bajda, Joe
Pitla, Neharaj
Gorantla, Vasavi Rakesh
author_facet Bajda, Joe
Pitla, Neharaj
Gorantla, Vasavi Rakesh
author_sort Bajda, Joe
collection PubMed
description Classical theories of cerebrospinal fluid (CSF) production and flow are taught throughout medical education. The idea that CSF is produced and/or filtered by the choroid plexus and flows in one direction throughout the ventricular system has been a largely accepted thesis. However, modern studies have called into question the validity of this hypothesis, suggesting that CSF does not move unidirectionally but rather is driven by microvessel contractions in a to-and-fro manner throughout the cerebrospinal system. Moreover, new insights suggest that in addition to CSF production, the exchange of fluids and proteins between the cortical vasculature and the interstitium may function as the brain’s version of a lymphatic system. This comprehensive review provides evidence for a different framework of CSF flow. One that includes perivascular pulsations that push CSF back and forth, allowing exchange between the CSF and interstitium, and with CSF production occurring throughout the cerebrospinal system. These findings could be revolutionary in understanding the pathophysiology of CSF flow and in the treatment of pathologies such as intracranial hypertension, hydrocephalus, Alzheimer's disease, and many others. 
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spelling pubmed-105931402023-10-24 Bulat-Klarica-Oreskovic Hypothesis: A Comprehensive Review Bajda, Joe Pitla, Neharaj Gorantla, Vasavi Rakesh Cureus Neurology Classical theories of cerebrospinal fluid (CSF) production and flow are taught throughout medical education. The idea that CSF is produced and/or filtered by the choroid plexus and flows in one direction throughout the ventricular system has been a largely accepted thesis. However, modern studies have called into question the validity of this hypothesis, suggesting that CSF does not move unidirectionally but rather is driven by microvessel contractions in a to-and-fro manner throughout the cerebrospinal system. Moreover, new insights suggest that in addition to CSF production, the exchange of fluids and proteins between the cortical vasculature and the interstitium may function as the brain’s version of a lymphatic system. This comprehensive review provides evidence for a different framework of CSF flow. One that includes perivascular pulsations that push CSF back and forth, allowing exchange between the CSF and interstitium, and with CSF production occurring throughout the cerebrospinal system. These findings could be revolutionary in understanding the pathophysiology of CSF flow and in the treatment of pathologies such as intracranial hypertension, hydrocephalus, Alzheimer's disease, and many others.  Cureus 2023-09-23 /pmc/articles/PMC10593140/ /pubmed/37876400 http://dx.doi.org/10.7759/cureus.45821 Text en Copyright © 2023, Bajda et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Neurology
Bajda, Joe
Pitla, Neharaj
Gorantla, Vasavi Rakesh
Bulat-Klarica-Oreskovic Hypothesis: A Comprehensive Review
title Bulat-Klarica-Oreskovic Hypothesis: A Comprehensive Review
title_full Bulat-Klarica-Oreskovic Hypothesis: A Comprehensive Review
title_fullStr Bulat-Klarica-Oreskovic Hypothesis: A Comprehensive Review
title_full_unstemmed Bulat-Klarica-Oreskovic Hypothesis: A Comprehensive Review
title_short Bulat-Klarica-Oreskovic Hypothesis: A Comprehensive Review
title_sort bulat-klarica-oreskovic hypothesis: a comprehensive review
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10593140/
https://www.ncbi.nlm.nih.gov/pubmed/37876400
http://dx.doi.org/10.7759/cureus.45821
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