Reduced perivascular cerebrospinal fluid pulsation in patients with ischemic stroke

Motivation: Pulsatile cerebrospinal fluid (CSF) flow alterations in ischemic stroke patients remains unknown. Goal(s): To investigate alterations in CSF pulsation in stroke patients with unilateral middle cerebral artery atherosclerotic stenosis. Approach: We recruited 97 patients with unilateral M1 segment stenosis and used dynamic diffusion-weighted imaging (dynDWI) to assess pCSF pulsation surrounding major cerebral arteries. Results: A significant 12% reduction in pulsatile pCSF volume was observed in the stenotic hemisphere compared to the control side. Patients with more severe stenosis exhibited a greater reduction, primarily downstream of the stenotic site. Impact: Our findings provide human evidence that arterial stenosis reduces pCSF pulsatility, suggesting a dual consequence for cerebrovascular conditions, affecting both blood flow and CSF flow.