The glymphatic and meningeal lymphatic systems eliminate waste from the central nervous system (CNS). They play a key role in patients with headaches, blood-brain leakages, and blood vessel constriction syndromes. This study evaluates these two subsystems of CNS for more understanding.

The study group consisted of patients suffering from reversible cerebral vasoconstriction syndrome (RCVS). About 92 of them had a blood-brain barrier (BBB) disruption, while 90 did not have it. A disease control group of 35 patients with cluster headache was also evaluated. A 3-tesla magnetic resonance machine performed the study using 3-D isotropic contrast-enhanced T2 fluid-attenuated inversion recovery imaging. All the subjects received an intravenous contrast agent called gadobutrol of 0.2mL/kg.

Out of 217 patients, the BBB group showed para-arterial tracer enrichment. And in both groups, there was para-venous and para-sinus meningeal contrast enrichment. It was also evident in cluster headache patients. In 32.3% of subjects, nodular leptomeningeal enhancement was observed. And 4 RCVS subjects who underwent 3-D imaging had gadolinium leakage for 54 minutes, which cleared completely after 18 hours.

The in vivo study depicted the subsystem transport and functioning. The non-invasive imaging test with contrast enrichment was also effective. This technique can assist further studies in establishing the clinical relevance of glymphatic clearance.