The Possible Role of CSF “Leaks” in the Genesis of MS Lesion

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

The Possible Role of CSF “Leaks” in the Genesis of MS Lesion

Postby Cece » Sat Oct 08, 2011 6:55 pm

http://www.fonar.com/news/pdf/PCP41_damadian.pdf

This is from the upright MRI study, but I thought we could look at it directly without concern about what the cause of the CSF leaks is. (The upright MRI study postulated it is due to CSF abnormalities resulting from cervical or spinal trauma, but CCSVI theory also allows for CSF flow abnormalities that could result in CSF leaks.)

The most important finding of this study is that cerebrospinal fluid “leaks” from the ventricles
of the brain into surrounding brain parenchyma, possibly secondary to trauma induced
blockages of CSF flow and resulting increases in ICP, may be playing an important
etiologic role in the genesis of Multiple Sclerosis. The existence of such possible CSF
“leaks” contributing to MS plaque formation could not be known until MS plaques themselves
became readily visible on medical images. The advent of MRI made this a reality
(1). Such CSF “leaks” could not have been seen prior to MRI, and a role for CSF “leakage”
in the genesis of MS could not have been known prior to the advent of MRI and prior
to the availability of phase coded MR imaging. These combined technologies have now
made CSF flows directly visible and quantifiable.

The first suggestion of this possibility arose from the T2 weighted sagittal brain image
of a patient with MS (Figure 1a, patient #1) displaying an explicit CSF connection between
ventricular CSF and one of the patient’s MS lesions (Figure 1a, arrow #1). Another
lesion in the same image exhibits a similar direct connection to ventricular CSF but in a
less striking manner (Figure 1a, arrow #2). In addition, the peri-ventricular distribution
of MS lesions naturally gives rise to the question that if MS lesions are not correlated in
any way to CSF hydrodynamics, why are they not randomly distributed throughout the
white matter of the brain, instead of being clustered around the ventricles of the brain.
Further consistent with the possibility that MS plaques originate as CSF “leaks” secondary
to trauma, is the existence of Dawson’s fingers (Figure I) where the “long axis of
the (MS) plaque” is “parallel with the white matter fibers in the corona radiata”, i.e., not
within the white matter fibers themselves but parallel to them. “Dawson’s fingers” might
well be the “leak” pathways of cerebrospinal fluid originating in the ventricle and joining
the body of the MS plaque within the brain parenchyma. Parallel to the white matter
fibers would be the path of least resistance for “leaking” CSF to diffuse within the brain
parenchyma, i.e., alongside the white matter fibers.

Protein is the principal ingredient, other than water, of the cerebrospinal fluid. CSF contains
approximately 15 to 40 mg/dL of protein (12). CSF gel electrophoresis has established that there are “more than 300 polypeptides in CSF” (13). In addition, “nine antigenic
species have been demonstrated in CSF that are absent in serum” (14). The question
naturally arises whether the “leakage” of these CSF antigenic proteins, like the
antigenic tau proteins they are known to contain (15), could be the source of the antigens
generating the autoimmune reactions known to be the origin of MS lesions.
If trauma induced “leakage” of CSF proteins into the surrounding brain parenchyma,
and particularly “leakage” of antigenic proteins, is contributing to the formation of MS
plaques, then the vascular expansion stenting of the Azygous and Internal Jugular Veins
recommended by Zamboni et al. (16) could be monitored after installation by UPRIGHT
® phase coded MRI measurements of CSF flow. Upright phase coded imaging of
CSF flow would assure that installed expansion stents are achieving the corrections of
CSF flow dynamics and intracranial pressure (ICP) that are needed to terminate plaque
generating CSF “leaks”.

It is possible that those patients who currently do not respond to the Zamboni vein expansion
stents or those who relapse are relapsing or not responding because the necessary
restoration of normal CSF hydrodynamics and normal ICP has not been fully accomplished
by the initial venous stenting procedure or is not being maintained.
Schoser et al. have reported that an increase in ICP is associated with an increase in
blood velocity in the straight sinus (17). One possible explanation, therefore, for the success
of the Zamboni et al. expansion stent procedure (16) could be that the Zamboni expansion
stent is diminishing blood flow velocity in the straight sinus and BVR (Basil Vein of Rosenthal), thereby reducing ICP and diminishing plaque generating CSF “leaks”.

I was just going to quote the inital two paragraphs, but the author continued on to directly discuss CCSVI.

And here he offers hope:
Myelogenesis is a normal physiologic process that repairs damaged myelin over time
(19). If the myelin injuring process, i.e., “leaked” antigenic CSF proteins, could be terminated,
there is the possibility that with the continuing injury from CSF “leakage” terminated,
the demyelinated axons of MS lesions could be remyelinated by normal
physiologic myelogensis and the MS lesions repaired.
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby jean-la-grenouille » Sun Oct 09, 2011 8:23 am

Thanks a lot for sharing this !
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby Cece » Sun Oct 09, 2011 8:40 am

There has never been an antigen found for MS but here are nine possible antigens in CSF.
And this:
Schoser et al. have reported that an increase in ICP is associated with an increase in
blood velocity in the straight sinus (17).

Do pwMS have increased velocity in the straight sinus? Is the straight sinus included in the Haacke Protocol MRV? I think it might be, but can't recall.
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POSSIBLE Role of CSF “Leaks” in the Genesis of MS Lesion

Postby MarkW » Sun Oct 09, 2011 9:28 am

Hello Cece,
I realise that you are trying to inform TiMs about upright MRI. However this information is likely to mislead people as it is highly speculative (count the number of uses of may could possibly etc). The authors do not discuss genetics, vit D, microbes, immune system, astrocytes etc etc but only give a narrow opinion on MS genesis. Highly misleading. This type of document helps the anti CCSVI neuros to argue that CCSVI is not proven and illogical.
Prof Zamboni talked about iron in his early papers. Now he calls the causes of MS, multifactorial. Lets stick with treating CCSVI syndrome and be very cautious about articles which seek to explain MS etiology.
Kind regards,
MarkW
PS Upright MRI is a diagnotic tool like IVUS.
Mark Walker - Oxfordshire, England. Registered Pharmacist (UK). 11 years of study around MS.
Mark's CCSVI Report 7-Mar-11:
http://www.telegraph.co.uk/health/8359854/MS-experts-in-Britain-have-to-open-their-minds.html
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby cheerleader » Sun Oct 09, 2011 9:47 am

Cece---
have to agree with Mark. The distribution of CSF is on the outside of the brain, would not explain gray matter degredation, iron deposition in the thalmus, enlarged veins, and lesions we see like Dawson's Fingers in MS, which all occur deep inside brain tissue. CSF surrounds the outside tissue...here's a good explanation on how CSF is absorbed in the brain. It explains the difference between the blood brain barrier (which encapsulates all the brain) and the arachnoid villi.

There is evidence that absorption of CSF by the arachnoid villi occurs by a valve-like process, permitting the one-way flow of CSF from the subarachnoid spaces into the venous sinuses. CSF absorption does not occur until CSF pressure exceeds the pressure within the sinuses. Once this threshold is reached, the rate of absorption is proportional to the difference between CSF and sinus pressures. A normal human can absorb CSF at a rate up to six times the normal rate of CSF formation with only a moderate increase in intracranial pressure.

If obstructions occur at the foramina between the ventricles, the ventricle upstream from the obstruction will enlarge, producing obstructive hydrocephalus. Occasionally, disease processes affect CSF removal. For example, obliteration of the subarachnoid space by inflammation or thrombosis of the sinuses will prevent clearance of fluid. When this occurs, CSF pressure increases and hydrocephalus develops without obstruction of the ventricular foramina. This is called communicating hydrocephalus.

http://www.ncbi.nlm.nih.gov/books/NBK27998/

This is the enlargement of the third ventricle in NPH Dr. Frohman was talking about in Bologna...

I asked Dr. Dake about this, because Jeff's left sinus was compressed...he said Jeff didn't have any signs of NPH or hydrocephalus...and that this would have been picked up at his lumbar puncture, which was normal except for banding. I think the upright MRI is a great invention, and will help...but trying to tie CSF leaks to CCSVI may prove more confusing. CSF leaks might be a result of inflamed and stenotic jugular veins inpinging CSF removal up above, but it's just a guess now. Of course, that doesn't mean it shouldn't be discussed...I think it's important we post about all the new developments.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby HappyPoet » Sun Oct 09, 2011 11:25 am

Cece,

Thank you very much for this thread! You go right on posting about whatever you think is important. There will always be those who complain.


Edits: typos
Last edited by HappyPoet on Mon Oct 17, 2011 7:24 am, edited 2 times in total.
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby Cece » Sun Oct 09, 2011 3:17 pm

Oh, dear, I am not trying to confuse or see conflict here. I absolutely agree that what I posted is speculative, and that I don't understand CSF as completely as I would like. I am not sure of the exact role of CSF abnormalities in CCSVI in MS but it is possible that improvements in CSF flow after venoplasty of the jugulars could explain some of the immediacy of immediate improvements. I had immediate improvements and it was amazing and bizarre to experience. I'm not sure how CSF leaks would arise from flow abnormalities. Based on genetics, the immune system must play a role, which is why I am interested in any discussion of antigens, but CCSVI itself gives plenty of room for the immune system to be involved with the BBB weakened and leukocytes getting across to the unhealthy, hypoxic neurons and oligodendrocytes.
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby civickiller » Sun Oct 09, 2011 10:36 pm

In 2004, Dr. Milan Radojicic proposed the ependymal stem cell niche disruption hypothesis highlighting the role of local ischemia, cerebrospinal fluid dynamics and cytotoxic factors in disrupting the ependymal stromal epithelium, along with periependymal stem/progenitor cells, thereby tipping the balance between injury and self-repair (i.e., neurogenesis and gliogenesis) in the central nervous system toward further degeneration over time.

so i found this but i really dont know how to interpret this. can someone please translate this to a simple minded person as myself?
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby Cece » Mon Oct 10, 2011 6:19 am

Here's the wikipedia on ependyma:
http://en.wikipedia.org/wiki/Ependyma
which mentions what you've quoted. Ependyma seems to be the endothelium of the ventricles, and is involved in the production of CSF fluid. The ependyma can become weakened and disordered as well, and probably does under CCSVI-induced conditions.
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby NZer1 » Mon Oct 10, 2011 2:05 pm

I think the key point to take from the article is that there is importance in CSF flow. If there are reasons that stop or slow the flow there are also symptoms occurring.
In MS these symptoms overlap, in the same way that CCSVI symptoms overlap what is said to be MS symptoms.
Until each situation is fully understood we are guessing. CSF flow improves with both CCSVI treatment and Spinal alignment, and the cause of each issue does link to injury for 'some' people, for others in vitro malformations, in others de-generative/aging processes and in likelihood for us all a combination of all of these.
It would be very unwise to cross any thing off the list and the use of Upright MRI is giving insights to issues that had been assumed 'not to be of concern'.
The more quality technology the better, especially when it comes to flows and pressures and vacuum.
Regards Nigel
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby blossom » Mon Oct 10, 2011 11:32 pm

when people and dr.'s didn't want to accept ccsvi we all got upset. and the good dr.'s are trying to get the kinks worked out and treatng and learning. now comes in the csf flow. here we go again. where is the common sence? if something is kinked, crushed, curved, pinched, too narrow, too wide, or missing or obstructed by a spur or an out of wack bone is putting pressure on something it shouldn't it's gonna give some of us trouble. the ones it don't are just damn lucky but that doesn't mean it won't cause grief in some other way. even though some of us have been branded with symptoms they call ms, we are still all individuals and that has gotten lost somehow along the way.

if the flow isn't right we're not right. if nerves are being compressed or screwed up we're not right. and all these inviromental screw ups and toxins and viruses bacteria etc. love stagnent places to chime in on this. yeah now it's their turn.

you get the wrong thing going on in the bowel like all this is a perfect example--you're in trouble big time. whats the difference. better not get kinked up in that part of the body right? then we're in deep s--t. well?????

well, i'm trying to make a point-but i may be the only one getting it.


unless there is some einstein hideing in woods that has this all figured out then --ok!

yes, it's late and ------
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby civickiller » Tue Oct 11, 2011 3:30 am

your not alone blossom, many of us are with you. too bad i couldnt "like" your post.

i preached Upper Cervical Care in almost every post, i told of the benefits i felt, pleading with everyone to at least go see a UCC Dr and get tested to see if they could benefit from that kind of care. i wonder how much people i actually convinced to go see a UCC Dr?, now with this recent discovery, how much people are gonna see a UCC Dr? unfortunately probably the same :cry:

wouldnt everyone want to do as much as they can help make their ccsvi surgery success chances higher or if ccsvi surgery didnt work for you? i know some cant but for those of you who can, i just dont understand why you havent :?
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby Cece » Tue Oct 11, 2011 6:23 am

blossom wrote:unless there is some einstein hideing in woods that has this all figured out then --ok!

His name is Dr. Zamboni, in the wilds of Italy. :-D
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby 1eye » Tue Oct 11, 2011 9:21 am

The distribution of CSF is on the outside of the brain, would not explain gray matter degredation, iron deposition in the thalmus, enlarged veins, and lesions we see like Dawson's Fingers in MS, which all occur deep inside brain tissue. CSF surrounds the outside tissue...


I thought the ventricles, full of CSF, were deep, inside the deepest brain tissue??
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
Patients sans/without patience
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Re: The Possible Role of CSF “Leaks” in the Genesis of MS Le

Postby NZer1 » Tue Oct 11, 2011 10:54 am

I agree 1eye, it seems this is another case where people publish things in a manor that supports their theory or observation!
The dynamic between volume of blood and volume of CSF when the pressure is fluctuating in the blood system and also going into vacuum reading, plus the black holes or atrophy seen in MS alters the available space for fluids within the brain.
The time that it takes for fluid to move compared with the time it takes to compress the other contents of the brain must be a factor in understanding what is happening to the containment of the fluids in their respective 'territories' of the brain. If the fluids are not contained or flow in an unsafe reverse flow within the 'spaces' there will be problems.
If the veins and CSF sacs are weakened with age or other issues such as diet, toxins, heavy metals and so on, then there going to be a challenge to contain the fluids and BBB will be crossed.
If there is spinal alignment issues and or Chiari Malformation issues and the CSF becomes displaced there will be symptoms end of story, what those symptoms are dx'ed as is any ones guess.
May you brain be supported by fluid not bone,
Regards Nigel
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