Perivascular spaces in the brain: anatomy, physiology and pathology
Open accessAbstract
Perivascular spaces include a variety of passageways around arterioles, capillaries and venules in the brain, along which a range of substances can move. Although perivascular spaces were first identified over 150 years ago, they have come to prominence recently owing to advances in knowledge of their roles in clearance of interstitial fluid and waste from the brain, particularly during sleep, and in the pathogenesis of small vessel disease, Alzheimer disease and other neurodegenerative and inflammatory disorders. Experimental advances have facilitated in vivo studies of perivascular space function in intact rodent models during wakefulness and sleep, and MRI in humans has enabled perivascular space morphology to be related to cognitive function, vascular risk factors, vascular and neurodegenerative brain lesions, sleep patterns and cerebral haemodynamics. Many questions about perivascular spaces remain, but what is now clear is that normal perivascular space function is important for maintaining brain health. Here, we review perivascular space anatomy, physiology and pathology, particularly as seen with MRI in humans, and consider translation from models to humans to highlight knowns, unknowns, controversies and clinical relevance.
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Hypertension induces hypertrophy of vascular smooth muscle cells and arterial wall stiffening, dampening pulsatility and compliance, reducing convective perivascular flow.
“Hypertension in particular induces hypertrophy of vascular smooth muscle cells, with a stiffening of the arterial wall that dampens arterial wall pulsatility and compliance, thus reducing convective perivascular flow (94, 100).”
From Glymphatic failure as a final common pathway to dementia (2020) · cites this paper as [100]
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- Authors
- Wardlaw, J. M., Benveniste, H., Nedergaard, M., Zlokovic, B. V., Mestre, H., Lee, H., Doubal, F. N., Brown, R., Ramirez, J., MacIntosh, B. J., Tannenbaum, A., Ballerini, L., Rungta, R. L., Boido, D., Sweeney, M., Montagne, A., Charpak, S., Joutel, A., Smith, K. J., Black, S. E., & colleagues from the Fondation Leducq Transatlantic Network of Excellence on the Role of the Perivascular Space in Cerebral Small Vessel Disease
- Affiliations
- UK Dementia Research Institute (GB)
- Yale University (US)
- University of Copenhagen (DK)
- University of Rochester Medicine (US)
- Sunnybrook Health Science Centre (CA)
- University of Toronto (CA)
- Stony Brook University (US)
- Inserm (FR)
- University of Southern California (US)
- Institut de Psychiatrie et Neurosciences de Paris (FR)
- UCL Queen Square Institute of Neurology (GB)
- Corresponding author
- Wardlaw, Joanna M.
- ORCID
- Wardlaw, Joanna M.
- Benveniste, Helene
- Nedergaard, Maiken
- Zlokovic, Berislav V.
- Mestre, Humberto
- Lee, Hedok
- Doubal, Fergus N.
- Brown, Rosalind
- Ramirez, Joel
- MacIntosh, Bradley J.
- Tannenbaum, Allen
- Ballerini, Lucia
- Rungta, Ravi L.
- Boido, Davide
- Sweeney, Melanie
- Montagne, Axel
- Charpak, Serge
- Joutel, Anne
- Smith, Kenneth J.
- Black, Sandra E.
- Venue
- Nature Reviews Neurology
- Published
- 2020-02-24
- Volume
- 16
- Issue
- 3
- Pages
- 137-153
- ISSN
- 1759-4758 (ISSN-L)
- 1759-4766
- OpenAlex
- W3007815224
- Cited by
- 870
- References
- 143
- Citations by year
- 2026: 153 · 2025: 169 · 2024: 138 · 2023: 136 · 2022: 138 · 2021: 90 · 2020: 44
- FWCI
- 14.11
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Nature Reviews Neurology (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Funders
- Rosetrees Trust
- Agence Nationale de la Recherche (ANR-18-IAHU-0001)
- Fondation Leducq
- Lundbeckfonden (R155-2016–552)
- Novo Nordisk Fonden (NNF13OC0004258)
- National Institute on Aging (RF1AG053991)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Cerebrospinal fluid and hydrocephalus
- Life Sciences › Neuroscience › Neurology › Barrier Structure and Function Studies
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- perivascular spaces, cerebral microvasculature, interstitial fluid clearance, glymphatic system, sleep, cerebral small vessel disease, Alzheimer's disease, neurodegeneration, neuroinflammation, cerebral hemodynamics, rodent models
- MeSH terms
- Glymphatic System, Animals, Brain Diseases, Humans
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