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Drainage of interstitial fluid and solutes from the brainstem has not been well studied. To map one drainage pathway in the human brainstem, we took advantage of the focal blood-brain barrier disruption occurring in a multiple sclerosis brainstem lesion, coupled with intravenous injection of gadolinium, which simulates an intraparenchymal injection of gadolinium tracer within the restricted confines of this small brain region. Using high-resolution MRI, we show how it is possible for interstitial fluid to drain into the adjacent trigeminal and oculomotor nerves, in keeping with a pathway of communication between the extracellular spaces of the brainstem and cranial nerve parenchyma. Copyright © 2021 the Author(s). Published by PNAS.


Aravinthan Varatharaj, Roxana O Carare, Roy O Weller, Mary Gawne-Cain, Ian Galea. Gadolinium enhancement of cranial nerves: Implications for interstitial fluid drainage from brainstem into cranial nerves in humans. Proceedings of the National Academy of Sciences of the United States of America. 2021 Nov 09;118(45)

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PMID: 34728566

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