GLYMPHATIC SYSTEM AND THE PATHOPHYSIOLOGY OF IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS - STATE OF THE ART

Abstract

INTRODUCTION: Idiopathic normal pressure hydrocephalus (INPH) is a neurological disease characterized by cognitive impairment, urinary incontinence, and gait disturbances. With advances related to imaging systems, capturing the function of the glymphatic system has become crucial for investigating INPH. This study aims to report the main advances in the study of the glymphatic system and its function in the pathophysiology of INPH. METHODOLOGY: The present study is an integrative literature review, where a broad search was performed in the main databases (Medline, Scielo, Web of Science, SCOPUS) using the terms "glymphatic system", "idiopathic normal pressure hydrocephalus", "neurosurgery", combined by Boolean operators. RESULTS AND DISCUSSION: The findings presented in this study show promise for the noninvasive investigation of neurological diseases that may be based on cerebral hydrodynamic dysfunction. However, other factors should be explored.  For example, cerebral deep venous dysfunction in patients with INPH leads to a difference in drainage capacity between the superficial and deep venous system, which will result in transmembrane pressure in the cerebral parenchyma, accelerating the disease process. FINAL CONSIDERATIONS: Therefore, this study concludes that in-depth investigation of the links between the glymphatic system and the pathophysiology of INPH can optimize current diagnostic approaches and prevent the early worsening of the disease, based on new classifications taking into account imaging tests and biomarkers of the cerebrospinal fluid.