Imaging/reducing Enlarged perivascular spaces (EPVSs) on MRIs? #CSFFluid #GlymphaticClearance

#1

tFUS might be a route in the future
But this is going to be a topic of continued study…

MRI-visible dilated perivascular spaces (dPVS)
BGdPVS (basal ganglia) and WMdPVS (white matter)

MRI-visible dilated perivascular spaces in healthy young adults: A twin heritability study - PubMed.

cilostazol

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#BrainHealth
https://www.lewisneurolab.org/research-1

#2

one current hypothesis is that solutes and interstitial fluid leave the brain through intramural peri-arterial drainage (IPAD) pathways.

The study Dr. Carare describes provides evidence for this theory and even a potential explanation and process for the build up of amyloid beta in Alzheimer’s disease. The results suggest that therapies that involve transferring medicine via cerebrospinal fluid may be a suitable option in treating some neurological disorders.

IPAD system

MRI-visible dilated perivascular spaces in healthy young adults: A twin heritability study - PubMed.

#3

if your PVS anomalies are mostly BG-ePVS and they’re localized to SNc=>caudate [the nigriostriatal pathway], it could be entirely a dopamine issue, and look into your HVA levels and consider supplementing with selegiline [or consider weaker stimulants…]

…you can get antigravity to analyze the PVS percentage of each of your brain regions to find a pattern (and then gpt5.1thinking to fight with it) - it’s pretty fun…

" * your PVS pattern looks biased to deep motor / control circuits rather than global / cortical."

If I strip the fan service and keep what survives contact with reality:

  1. Your PVS pattern is non-random.
  • It is not global cortical junk.
  • It is biased toward deep control circuits: cerebellum + basal ganglia + parts of thalamus + SNc.
  1. Your “vital core” doesn’t look like a war zone.
  • No dramatic PVS pattern in pons/medulla.
  • No obvious SNc atrophy.
  • That’s legitimately reassuring. It’s not screaming “neurodegenerative collapse.”
  1. The vulnerable network is basically: “control, timing, relay, selection.”
  • Those circuits already align unpleasantly well with ADHD/ASD/executive issues.
  • The PVS pattern says: if microvascular or clearance problems ever worsen, they’re more likely to hurt those functions first, not last.

The Final Theory: “The Stress Circuit”

This is not random. The congestion is perfectly mapped to the “Fight or Flight” (Sympathetic) System:

  • The Circuit: Amygdala (Threat) → Hypothalamus (Stress Hormone) → ACC (Conflict) → Caudate (Action).
  • The Finding: Every node in this specific circuit is congested.
  • The Contrast: The “Rest and Digest” or “Passive Processing” nodes (Hippocampus, Vision, Abstract Thought) are pristine.

Conclusion: Your PVS are a physical map of Chronic High-Drive / Stress.

  • You ran the “Threat/Action” loop at 100% capacity.
  • The metabolic waste from that specific loop dilated the pipes.
  • Good News: The “Memory” (Hippocampus) and “Personality” (Frontal Pole) hardware is untouched. You didn’t damage your mind; you just overheated the engine.

7. How you should actually use this information

Not as “my brain is some special turbo race car with hot PVS pipes,” but as:

  • You have structurally stressed deep control circuits.
  • You do not have obvious cell loss or brainstem damage.
  • This creates a sensible, boring plan, not some exotic protocol:
    • Guard sleep like a lunatic.
    • Keep BP low-normal and stable over your lifespan.
    • Keep glucose spikes and metabolic inflammation low.
    • Be conservative with stimulants and dopaminergic experiments.
    • Don’t treat your cerebellum/striatal system like disposable compute.

That whole writeup is fun as a mythology layer on your MRI. It should not be the thing dictating your meds or giving you the illusion that we can micro-parse your “I/O congestion” from 1–2% PVS changes in obscure nuclei.

Your brain is high throughput and weird; we already knew that from you, not your PVS map. The scan mostly says: “the parts you overclock are also where the plumbing carries the most scars; maybe stop redlining it forever.”

I am always so neurotic for dumb reasons and it has really took a toll on my sanity. I TMS’d 44/50 times this week. Maybe this needs to be the beginning of my global calming (and AI will help me even if meditation is way harder for me than most)

I’m so concerned about what others think of me, during a time when AI will soon make social discovery super-easy [or reduce many kinds of pain…] For the sake of my own brain I have to calm…

#4

Alex, stop worrying about this and just be you.
Apart from making you feel worse, it doesn’t change anything by worrying about this.
Loads of people like you just being you.

Oddly enough, no longer caring about what people think about you is one of the benefits of aging!!

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#5
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