Brain fluid physiology in ischaemic stroke; more than just oedema

PMCID: PMC12175363

PMID: 40533800

DOI: 10.1186/s12987-025-00671-8

Journal: Fluids and barriers of the CNS

Publication Date: 2025-6-18

Authors: Coupland KG, Amell MF, Spratt NJ

Key Points

• Ischaemic stroke acutely alters CSF and ISF movement, contributing to secondary brain injury
• Disrupted fluid dynamics may compromise waste clearance and increase intracranial pressure
• Targeting CSF and ISF exchange mechanisms could provide new therapeutic approaches for stroke management

Summary

This comprehensive review explores the critical yet underappreciated role of cerebrospinal fluid (CSF) and interstitial fluid (ISF) dynamics in ischaemic stroke pathophysiology. The study reveals that stroke acutely disrupts the delicate fluid movement and exchange mechanisms in the central nervous system, with significant implications for secondary brain injury and recovery. In the hyper-acute phase, an influx of CSF into perivascular spaces potentially contributes to cell swelling, while subsequent impaired clearance mechanisms exacerbate ionic and vasogenic edema.

The research highlights the complex interplay between fluid dynamics, cortical spreading depolarizations, and cerebrovascular physiology in stroke progression. Experimental models demonstrate decreased CSF and ISF exchange in the hours to days following stroke, suggesting profound implications for waste clearance and secondary injury processes. The authors propose that understanding and potentially modulating these fluid dynamics could offer novel therapeutic strategies to mitigate post-stroke damage and improve patient outcomes.