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Cerebrospinal fluid outflow along lumbar nerves and possible relevance for pain
research: case report and review
#MMPMID25165054
Bechter K
; Schmitz B
Croat Med J
2014[Aug]; 55
(4
): 399-404
PMID25165054
show ga
CSF outflow through the cribriform plate near the olfactory nerves and the
outflow along brain and spinal nerves are together known as peripheral CSF
outflow pathway (PCOP). It is still not clear whether the PCOP has pathogenetic
relevance. Our previous clinical observations have indicated that CSF may
interact with nerves along the PCOP and in this article we present our finding of
CSF outflow demonstrated by myelography in a single patient. We also discuss
unexplained experimental pain pathomechanisms against the background of the PCOP
hypothesis. We observed that CSF flowed along lumbar nerves in distal direction
at a speed of about 10 cm per hour on its way through the tissues, mainly
muscles. Total CSF outflow volume at the lumbar site was remarkable. CSF outflow
at lumbar nerves was also documented by neuroradiology. It is plausible that CSF
signaling serves for interaction with nerves along the PCOP, which could explain
previously unknown pathomechanisms in pain generation. Experimental findings of
tactile pain hypersensitivity within lumbosacral pain pathways could be explained
by releasing of molecules, microparticles, or exosomes into the CSF by mast
cells, which then move with CSF outflow along the PCOP and interact with nerves,
initiating even retrograde synaptic stripping.
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