This Is MS Multiple Sclerosis Community: Knowledge & Support

It should be noted that this paper was published in Child's Nervous System. It's actually a good paper that underscores many as yet unanswerd questions about hydrocephalus and CSF flow such as where it is absorbed. The problem is that it mixes childhood and adult hydrocephalus.

The debate regarding where CSF is absorbed is old and still not fully understoood. Most researchers still maintain that it is mostly absorbed by the archnoid granulations (AG). The AG, however, aren't formed at birth and so CSF uses other outlets until they do. The role and location of the AG in the superior sagittal sinus and CSF absorbtion is most likely due to upright posture. Regardless of where it is absorbed, once it is absorbed all CSF enters the venos system before exiting the cranial vault so that obstruction to venous outflow can effect CSF flow.

Another point is regarding compliance which is too lengthy to go into here. One point to be made, however, is that loss of vascular compliance occurs with aging and is associated with decreased blood and CSF flow. In this regard, I suspect that decreased CSF flow and production can cause the brain to sink into a pressure conus (Chiari 1) and block blood and CSF flow between the brain and cord. This will cause CSF volume to increase in the cisterns and subarachnoid space. Consequently, there is an increased incidence of Alzheimer's assoicated with circulatory degeneration due to conditions such as diabetes and heart failure which decrease blood and CSF flow in the brain.

Still another point missed in this paper is cranial (skull) compliance. The cranium in children and young adults is compliant. It gets less compliant with age as the sutures close in adults. It is my opinion that the increase in intracranial pressure in children is due to the compliance of the cranium. The closed sutures of the skull in adults resist an increase in CSF pressure.

Lastly, this paper only discusses intracranial obstructions such as aqueductal stenosis in the cause of hydrocephalus and overlooks extracranial blockages in the craniocervical junction.

While we continue to debate and research the all the nuicances of CSF production, flow and physiology, cine MRI is showing what actually happens and will continue to improve.

hi dr. flanagan, i always have interest in your input. this beyond crazy weather this past yr. and especially this up down stuff and humidity. i know we can't control mother nature. but the barometric pressure always messed with me. especially during the change. once it settled i'd feel better. this last month i worsened faster than anytime in the last 20 yrs. of course i got the cervical worsening and hopefully my veins are still open "i'll know in a wk. or so" but this darn weather. i've spoke to others who in the last mo. were doing worse.

anyway, found this interesting. i was even wondering about the timing of say ccsvi treatment or even flow studies. etc.

i know this is way out there what i'm thinking but hey--this is what you get for being so darn smart. people like me asking these questions. here goes--


Periods of low atmospheric pressure are associated with high abdominal aortic aneurysm rupture rates in Northern Ireland.

D. W. Harkin, M. O'Donnell, J. Butler, P. H. Blair, J. M. Hood, and A. A. B. Barros D'Sa

Regional Vascular Surgery Unit, Royal Victoria Hospital, Belfast.D. W. Harkin: d.w.harkin@qub.ac.uk
Author information ► Copyright and License information ►
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This article has been cited by other articles in PMC.
Abstract

Seasonal and circadian variation in the incidence of ruptured abdominal aortic aneurysm (RAAA) has been reported. We explored the role of atmospheric pressure changes on rupture incidence and its relationship to cardiovascular risk factors. During a three year-period, 1st April 1998 and 31st March 2001, data was prospectively acquired on 144 Ruptured Abdominal Aortic Aneurysm (RAAA) presenting to the Regional Vascular Surgery Unit at the Royal Victoria Hospital, Belfast, Northern Ireland. For each patient the chronology of acute onset of symptoms and presentation to the regional vascular unit was recorded, along with details of standard cardiovascular risk factors. During the same period meteorological data including atmospheric pressure and air temperature were recorded daily at the regional meteorological research unit, Armagh. We then analyzed the monthly mean values for daily rupture incidence in relation to the monthly values for atmospheric pressure, pressure change and temperature. Furthermore atmospheric pressure on the day of rupture, and day preceding rupture, were also analyzed in relation to days without rupture presentation and between individual ruptures for various cardiovascular risk factors. Data demonstrated a significant monthly variation in aneurysm rupture frequency, (p<0.03, ANOVA). There was also a significant monthly variation in mean barometric atmospheric pressure, (p<0.0001, ANOVA), months with high rupture frequency also exhibiting low average pressures in the months of April (0.24 +/- 0.04 ruptures per day and 1007.78 +/- 1.23 mB) and September (0.16 +/- 0.04 ruptures per day and 1007.12 +/- 1.14 mB), respectively. The average barometric pressures were found to be significantly lower on those days when ruptures occurred (n=1127) compared to days when ruptures did not occur (n=969 days), (1009.98 +/- 1.11 versus 1012.09 +/- 0.41, p<0.05). Full data on risk factors was available on 103 of the 144 rupture patients and was further analyzed. Interestingly, RAAA with a known history of hypertension, (n=43), presented on days with significantly lower atmospheric pressure than those without, (n=60), (1008.61 +/- 2.16 versus 1012.14 +/- 1.70, p<0.05). Further analysis of ruptures grouped into those occurring on days above or below mean annual atmospheric pressure 1013.25 (approximately 1 atmosphere), by Chi-square test, revealed three cardiovascular risk factors significantly associated with low-pressure rupture, (p<0.05). Data represents mean +/- SEM, statistical comparisons with Student t-test and ANOVA. These data demonstrate a significant association between periods of low barometric pressure and high incidence of ruptured aneurysm, especially in those patients with known hypertension. The association between rupture incidence and barometric pressure warrants further study as it may influence the timing of elective AAA repair





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Hi Blossom,
It's a good question and an old mystery. Patients with rheumatological problems often feel worse and notice increased inflammation, edema (swelling) and pain during low barometric pressure conditions. As I mentioned many times my mother had wicked rheumatoid arthritis so I became aware of weather effects long ago when doctors still scoffed at the notion. From my experience the most notable differences occur during the change in pressure when it starts to drop. I suspect the cause has to due with the decrease in external pressure acting on cell walls. The decrease in external pressure allows them to leak and swell more easily. High pressure on the other hand is similar to wearing compression socks and garments. It increases external pressure on the cells and keeps fluids in and swelling down. There are pressure receptors called Pacinian corpusles, as well as others, that detect pressure changes and cause pain when sufficiently provoked.

Dear Dr Flanagan

Im wondering if you could give me a bit of orientation.

I was diagnosed with relapsing remitting MS sommer last year, I’m taking no drugs.
February this year I was tested negative for CCSVI (MRV images see below).

Here is a short history of my hard luck so far:

age - text / symptom

-- born in Central Asia, grew up there

16 - moved to Central Europe (Germany) at age 16

around 16 to 25 - long episodes (2-4 days) of headache (in the back of the head and on the sides)

-- fatigue since early youth

22 - developed heat intolerance (summer 1998)

25 - started jogging to reduce fatigue

25 - severe back pain in the region of the right shoulder blade (comes and goes since then)

27 - tinitus in right ear (summer 2003) -> went to several doctors because of the tinitus, one of them saw that my jaw joint on the left side was more worn than on the right side, I was sent to see a dentist / jaw specialist

27 - removal of wisdom tooth 2003 (both sides, tinitus was gone but only for ca. one week, then it came back)

27 - brain MRI, the radiologist told me there were small white spots but didnt know what to make of them

28 - car accident with whiplash

-- between 25 and 35 headache got better, satisfactory health condition

34 - had to give up jogging because of problems with my left knee, the orthopedist also found that I have pelvic obliquity (see x-ray image below)

35 - May 2011: went to sit down on a chair but it had slide away, felt on the floor and hurt my tailbone badly

35 - June 2011: sensory disturbances on the right tigh, disturbance of fine motor skills on the right hand

35 - July 2011: brain MRI, 8 white matter lesions,

35 - October 2011:I was diagnosed with MS

I’m currently seeing two osteopaths (in Berlin/Germany) because of severe back pain ( the heads of the ribs had slid out / snatched out in the area of thoracic spine, right side).

The 1st one told me there was a problem with my diaphragm, its kind of pulling on my spine (at least that’s how I understood it) and needs to be addressed first.
She told me there are also problems with my thoracic spine and cervical spine, but any treatment of these upper areas would be useless unless the diaphragm problem is treated.
Her diagnosis about the diaphragm was confirmed later on by MRI/X-ray of thoracic spine (diagnosis: scoliotic malposition of the upper
thoracic spine with moderate degenerative chondrosis, secondary finding: distinct diaphragmatic elevation left side) see x-ray images below.

The other one tells me there is an even bigger problem with my jaw (i.e.TMJ) and it’s much more pronounced than the problem with the diaphragm.
He is addressing the back issues but wants the focus on TMJ.

I dont know who is right or maybe these issues are interconected....

My question is: can pelvic obliquity or diaphragm elevation cause problems in the upper areas (atlas misalignment, problems with jaws)?

I’ve given up seeing my orthopedist and neurologist, unfortunately I cannot find any UCC doctors in Europe, do you have any recommendations for such doctors in Europe?

Thank you very much & greetings from Berlin

MRI Thoracic Spine 2012-06-06


MRV





X-rays (Spine, Pelvis, Jaws)

"My question is: can pelvic obliquity or diaphragm elevation cause problems in the upper areas (atlas misalignment, problems with jaws)?"

Hello Tore,
You appear European, not Asian on your scans. The answer to your question is yes. Pelvic obliquity can cause problems in the diaphram, upper cervical spine and the jaw. Pelvic obliquity, however, is a very general, non-specific term used to describe a misalignment. You can't fix structural deformations (misalignments) if you don't know the source and direction of the strain.

Your cervical x-rays show a reversal of the normal cervical curve, called kyphosis. It also shows significant ligament laxity (loose joints) and slippage called listhesis of the cervical segments. The x-rays are not good or specific enough for determining the condition or misalignment of your upper cervical spine. They do show a slight head tilt to the right and rotation of C2 to the left.

The pelvic x-rays are likewise inadequate for determining specific misalignment. The tops of the pelvis and the lateral (side) borders of the iliac bones are missing. The 4th and 5th lumbar vertebral segments are also missing, and there is too much unrelated exposure of the femurs and space between your legs. You need to know the curve of the lumbar spine. I prefer 14x36 inch AP views when possible to asses curves such as Fernando posted early on in this thread. You also need to check for actual and functional leg length differences. Your pelvis is tilted to the left side, which is the low side that bears more compression loads and is the side of your knee problems which may likewise be related to the pelvic misalignment.

The pelvis, however is as complex as the upper cervical spine and requires the same accurate analyitcal approach in examination and correction. The pelvis is linked to the legs below and the lumbar spine, flank muscles, and diaphram above. The pelvis is the foundation of the spine. The footers of the foundation are in the legs and feet. As in any structure, shifiting and sinking foundations effect the entires structure. The greatest deformation often occurs in the roof. Think of the Leaning Tower of Pisa. Unlike rigid structure, the flexibiltiy of the spinal column has the ability to bend and curve to compensate for sifts in the foundation. In this regard, in contrast to the left low pelvis, your thoracic spine has a tight curvature to the right that occurs over a limited number of segments. Your head it also slightly lower on the right and your second cervical vertebra appears rotated to the left. You also have significant degeneration of the right TMJ.

The pelvic misalignment and thoracic curvature in your spine are most likely effecting neurovascular tunnels in your pelvic and thoracic outlets. The cervical kyphosis and upper cervical misalignment are effecting neurovascular tunnels in your skull and uppper cervical such as the foramen magnum, spinal canal and suboccipital cavernous sinus.

Certain characteristics of your thoracic curve make me suspicious that there is something missing in your case history such as early childhood trauma. The whiplash and sit down fall that occured later in life most likely made made matters worse.

I just got news from Dr. Rosa about a favorable review from the Michael J. Fox Foundation for further research into the role of structural abnormalities of the craniocervical junction in obstruction to blood and CSF flow and subsequent neurodegenerative processes and diseases such as Parkinson's. They are now discussing funding.

GREAT NEWS!! you doc's better be prepared---dr. oz will be a calling. this is soooo long overdue. i'm so happy----

Great news. Dr F!!!!!!!!!!!!!!!!!!!! I am so looking forward to meeting Dr Rosa on Friday.

Thanks Blossom and Dania. Good luck this weekend Dania. The studies have been most enlightening.

Thx very much for your reply Dr. Flanagan.

I felt down badly several times when I was a child.
My cousin was a rings gymnast, we had a pair of rings hanging from the ceiling in our house.
For reasons of fun or whatever he used to hung me up on the rings and I had to do excersises, I felt down several times
and dislocated my shoulder and I think also my wrist (I Think I was around 5, the rings were hanging quite high, I would guess appr. 1.8m above ground).

when I look at my images since childhood I think I can see that there was this head tilting ever since school enrollment.

I’m currently seeing two osteopaths (in Berlin/Germany) because of severe back pain ( the heads of the ribs had slid out / snatched out in the area of thoracic spine, right side).

The 1st one told me there was a problem with my diaphragm, its kind of pulling on my spine (at least that’s how I understood it) and needs to be addressed first.
She told me there are also problems with my thoracic spine and cervical spine, but any treatment of these upper areas would be useless unless the diaphragm problem is treated.
Her diagnosis about the diaphragm was confirmed later on by MRI/X-ray of thoracic spine (diagnosis: scoliotic malposition of the upper thoracic spine with moderate degenerative chondrosis, secondary finding: distinct diaphragmatic elevation left side) see x-ray images below.

The other one tells me there is an even bigger problem with my jaw (i.e.TMJ) and it’s much more pronounced than the problem with the diaphragm. He is addressing the back issues but wants the focus on TMJ.

Tore,
The falls from the gymnastic rings onto your neck and upper back explains the ligament damage, backwards cervical curve called kyphosis, right head tilt, upper cervical misalignment and sharp angle scoliosis to the right side in your thoracic spine. Your ribcage also appears to be slightly caved in on the left side which would explain the displacement of the diaphram upwards. You probably fell onto the left side of your neck, shoulder and ribcage. You most likely jammed the jaw on the right side at the same time.

The TMJ is not the source of your MS symptoms. The upper cervical misalignment, the cervical kyphosis and the thoracic scoliosis are effecting the alignment of the spinal canal and thus blood and CSF flow. The pelvic misalignment further complicates the problem because it strains the tail end of the cord. The back pain is most likely due to muscle spasms due to the twist in your spine and tension on the cord coming from both ends. The lower spine needs to be aligned. You have a psoas mucle problem that needs to be addressed. The psoas muscle attaches to the underside of the diaphram. The movement of the diaphram also needs to be restored as much as possible. I successfully worked on many diaphram problems caused by a many different problems such as hiatal hernias, pregnancy, rib fractures, thoracic surgery and seatbelt injuries from car accidents. In cases such as yours you will also need to address diet as well so that you don't cause additional pressure problems beneath it and further displacement.

Not wanting to distract the conversation.

Has anyone looked through this article by Dr Paul Thibault?
http://www.cosmeticcentre.com.au/client ... 043331.pdf

I posted this some back because I tested positive for CPn with the self test and a few days ago my Neuro has said she is not sure about my PPMS dx. I have had a few gallons of blood taken and have to go back for more to search for Lyme as well as a more reliable CPn test. I am waiting on her letter so I can critique her skills

Keep smilin'
Nigel

nzer1--very very interesting. as said the plot thickens. dr. flanagan's input is always respected by me. i still feel the spine plays a very very big part in all this. for some of us hopefully it's the total answer. but, more than one factor in some may be at play here. or, for some cpn might be the answer. we are all individuals with these symptoms someone named ms.

for me, my spine is a mess and my symptoms started after trauma and i feel it's my main problem. buttttttt--i have still stuck in the back of my mind the fact that the rat i was married to also his previous wife has symptoms they named ppms. sooooo????--the plot can get very thick.

Thanks Blossom,
I have always wondered if some of us have Transverse Myelitis from injury and that gets aggravated (repeatedly over time) and then Neuro's call it MS because they don't know about general health and outcomes over time. The bacteria or virus gets in through the injury sites and then the disease process spreads after crossing the BBB. The weak points made by the infection cause issues when flow refluxes and the BBB is crossed again. All compounding on a primary event and spreading itself to cause more harm and confusion!
Nigel

I sent TCI my lumbar, cervical, and brain MRIs and said tethered cord questionaire.Said I didn't have tethered cord even though I have a lot of the symptoms.Haven't had MRI that go any lower than lumbar which show the first two sacral vertebrae. Should I get MRI that would show my cocyx and filum terminale. Talked with blossom about never having the sensation of hunger. Still have the hoarseness problems and calf muscle pain and pain in buttocks.
See orthopedic surgeon next week. He thought something like Celebrex might help. The methyl prednisone didn't. Don't know. Beyond frustrated. Can't help but feel like there has got to be a connection between child birth and the optic neuritis that occured 6 to 9 months later. My daughter's mri didn't show any evidence of MS. Frustrating that they don't know the cause or how to treat. Just want to drug. Tore I've had my share of falls on mybackside on gymnasium floors associated with highschool basketball.