Letters to the Editor  |   April 2016
Response
Author Notes
  • Chair, Internal Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, Virginia 
Article Information
Neuromusculoskeletal Disorders / Osteopathic Manipulative Treatment
Letters to the Editor   |   April 2016
Response
The Journal of the American Osteopathic Association, April 2016, Vol. 116, 200. doi:10.7556/jaoa.2016.041
The Journal of the American Osteopathic Association, April 2016, Vol. 116, 200. doi:10.7556/jaoa.2016.041
Heemstra points out some key citations worthy of a lengthier conversation on lymphatics in the central nervous system (CNS).1 She suggests that there is enough existing literature to support the existence of lymphatics and drainage in the CNS; however, I disagree. 
Unfortunately, I was not able to access the edition of Gray ’s Anatomy that she cites in her letter. Most anatomy textbooks and literature that I have referred to clearly state that there is not enough evidence to support lymphatics in the CNS. For example, in Junqueira’s Basic Histology, Mescher states, “With exceptions such as the bone marrow and most of the CNS (central nervous system), most tissues with blood microvascula-ture also contain lymphatic capillaries (or lympathics).”2 
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