NEW: Flow quantification by Dr. Haacke

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

NEW: Flow quantification by Dr. Haacke

Postby cheerleader » Wed May 18, 2011 10:17 am

Dr. Haacke discusses flow quantification in the YouTube video segment linked here:
http://www.youtube.com/user/HubbFound?b ... QpxR1nHOIg

six minutes in....

"I believe Zivadinov's work only used the magnitude images, he did not use flow quantification. Now, I can happily tell you that Robert just sent several of his people to spend time with us a few weeks ago and learn how to do flow quantification so they will be adding this to their future studies....

We can get the cross-sectionals for every vessel...we can calculate the total cardiovascular input into the brain and the venous out put from the brain. Here's a case of normals, where we're looking at the major veins, they flow at about 10cm per second. They don't have these wild swings associated with them. Here's a case.... all four of the major veins in this individual have come to almost zero or reflux flow, and so because of that, in order to get that blood out, talk about a stress on your system, the flow has to double in the 2nd half of the cardiac cycle and becomes 20 cm per second in order to get it out. I've actually seen flow as high as 60 cm per second in an MS case because of this type of problem."


0 cm. of blood on this first half of the cardiac cycle, then 20cm on the second half. 60 cm of blood in a pwMS. This is NOT NORMAL.
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dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby Cece » Wed May 18, 2011 10:53 am

I am trying to think what effect it would have to have these extreme swings. It sounds like, by speeding up the flow, the flow does all get out?

If it's not the iron in the brian that gets you, it's the hypoxia, and if it's not the hypoxia, it's the extreme fluctuations in flow. Amazing the harm a bad 'leaflet' or two can do.
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Postby ikulo » Wed May 18, 2011 12:02 pm

Regarding Dr. Haacke's "stress on the system"... An article noting the "coincidence" of raised CSF and cranial pressure with MS. The authors suggest that the O-bands caused an increased pressure, though in my opinion this process is backwards. Nevertheless, they do illustrate a correlation (granted in a very small sample) between raised CSF and MS.


The authors hypothesize that, during the flares of multiple sclerosis, the increased IgG and oligoclonal bands cause changes in the osmotic and oncotic pressures within the cerebrospinal fluid, thereby disturbing the blood brain barrier and elevating the intracranial pressure.

Other theories to explain a causal relationship would need to explore ways the multiple sclerosis process could decrease cerebrospinal fluid resorption or increase production. None of our three patients had elevated spinal fluid protein levels or significant cellular content. It would be highly unlikely that raised intracranial pressure alone would cause the episodic neurologic symptoms and signs as well as the MRI findings in our cases. However,
it is conceivable that autoimmune triggers could result in both diseases.

Finally, the treatment of presumed demyelinating disease frequently involves the use of corticosteroids, agents whose use as well as whose rapid withdrawal have been associated with raised intracranial pressure. All of our patients had papilledema noted prior to any corticosteroid treatment.


http://content.lib.utah.edu/cdm4/item_v ... CISOPTR=81 (from 1994)

[/quote]

Also:

Increased intracranial pressure in a case of pediatric multiple sclerosis.
http://www.ncbi.nlm.nih.gov/pubmed/18539995

[Efferent methods of the treatment of cerebrospinal fluid hypertension in exacerbation of multiple sclerosis].
http://www.ncbi.nlm.nih.gov/pubmed/1647618


Lastly, does anyone have an image from Hubbard's San Diego presentation where he shows the pressure system drawn up by an engineer? Can't find that image in a nice format.
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Postby Cece » Wed May 18, 2011 12:08 pm

I'm past my depth, does this have any connection with classic fluid mechanics as presented at ISNVD?

http://ccsvism.xoom.it/ISNVD/Other/Abstract-Tucker.pdf

I'm not sure that's the one I was looking for. Sou had mentioned 'deadly CSF oscillations' back in the ISNVD thread. The mention here of wild swings reminded me of that.
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Postby Loobie » Wed May 18, 2011 12:58 pm

Dr. Siskin uses the flow 'stuff'. He's all about the flow and not just stenosis now.
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Postby cheerleader » Wed May 18, 2011 3:45 pm

Loobie wrote:Dr. Siskin uses the flow 'stuff'. He's all about the flow and not just stenosis now.


Yup. You got it, Lew.
"It's the flow, not the architecture."
Dr. Paolo Zamboni said those words to me in Bologna 2009. He was concerned that if doctors treated only stenosis, and did not address flow, they wouldn't be getting at the cause of CCSVI.

Cece, yes, it's about the classic fluid mechanism model that was shown in Bologna in March and the research by Dr. Beggs and Dr. Tucker.
http://ccsvism.xoom.it/ISNVD/Abstract-Beggs.pdf

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dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby 1eye » Wed May 18, 2011 8:55 pm

I read this short but very meaningful article, and I remembered a comment of mine from times past. I was brought up with electronics symbols. Eventually, after learning how they are physically constructed, it became apparent to me why, for instance, a resistor was a zigzag line and an inductor was a springy-looking thing. When I encountered some other physical mathematics, some of the symbols used were of a spring, a weight on a string, a brush or something that represented friction (I was never quite clear what it was supposed to be) etc, but the ones I was most familiar with, because of their usefulness, were the electronics symbols.

It strikes me that there is no such symbology for diagramming the workings of the human body. I don't know if there is such a set of symbols for terms in hydrodynamics, but it seems to me they, and probably a lot more, would come in handy. I took this paper and reduced it to a set of unique terms, at least some of which could be featured in a diagram illustrating this paper, and some of which could be shown as standard symbols, marked with scientific units of quantity or describing somehow their physical properties quantitatively. Some things could be shown with more generic symbols, such as a large arrow, for instance, to indicate "bulk flow". Others could be more pictorial. Then more people, I think, could be "on the same page".

Please excuse this list as it is meant only to be an example and not to be rigorous or exact or complete in any way.

It would be nice if there were well-understood symbol rules too, like: Greek symbols for fluid properties, etc.

angioplasty
blood flow
the heart
blood pressure
the brain
bulk flow
cerebral blood flow (CBF)
cerebral blood vessels
cerebral vascular circuit
cerebral veins
cerebral venous system
cerebrospinal fluid (CSF)
collateral rerouting
cortical region
cortical veins
CSF
CSF efflux
CSF systems
deep venous systems
superficial venous systems
endothelia
extensive collateral rerouting
extracranial venous pathways
extracranial venous stenosis
fluid dynamics
hydraulic resistance
hypertension
hypoxia-like metabolic injury
hypoxia
MS lesions
normally appearing white matter
periventricular region
periventricular veins
pressure
pressure drop
pressure gradient
sinuses
sphincters/starling resistors
SSS
stenosis
stenotic vessels
stress
subarachnoid space
superior sagittal sinus (SSS)
system resistance
the venous system
thin walled vessels
veins
venous pressure
venous sinuses
very low pressures
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
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Postby 1eye » Thu May 19, 2011 8:11 am

Further reasons for a diagrammatic representation: I understand electronics best when I think of it as plumbing: there is something very analogous about the movement of charge through metal conductors and the movement of iron oxide in blood around the body. They are both fluids. Blood flow obeys fluid mechanics, hydraulic principles which are very analogous to the way charges move. There are many mathematical concepts and physical principles which must be kept in mind when predicting the movements and current location of the fluids. I know this is hard to translate into clinical terms, but that is a lot like what I did for a few years of my life, in engineering design pursuits and troubleshooting.
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
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Postby fogdweller » Thu May 19, 2011 11:43 am

Cece wrote:I am trying to think what effect it would have to have these extreme swings. It sounds like, by speeding up the flow, the flow does all get out?


Remenber that the stress on the walls of the vessel purportedly agraveate or cause the BBB leakage. If reverse flow can do this, I suppose undue rapid flow can harm the vessel walls. Also the steady flow of oxygen and glucose in and metabolic waste products out would, over time, be different that busts of each. Since MS is a looong term chronic disease, a slight difference over the 70 beats you experience every minute could lead to a problem over years that would not be immediately noticeable due to slight variations of normal. one reason it is hard to study.
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Postby elliberato » Fri May 20, 2011 8:30 am

Make sure you have popcorn, a comfy pillow, and a blankie...
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Postby 1eye » Sat May 21, 2011 4:56 pm

elliberato wrote:Make sure you have popcorn, a comfy pillow, and a blankie...


Things are getting too intellectual and complex for me. I'm sorry to have to leave this discussion to the experts... the terminology is getting a bit arcane as well, for my liking.
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