cerebrospinal fluid flow

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

cerebrospinal fluid flow

Postby Cece » Fri Dec 16, 2011 2:45 pm

http://quizlet.com/3337069/flow-of-cere ... ash-cards/

I thought this was useful. The images are a little small, but the text is simple enough. It takes you through the eight steps in the flow of cerebrospinal fluid.

Step 1: Choroid plexus in the lateral ventricles produces CSF.
Step 2: CSF flows through interventricular foramina into third ventricle.
Step 3: Choroid plexus in the third ventricle adds more CSF.
Step 4: CSF flows down cerebral aqueduct to fourth ventricle.
Step 5: Choroid plexus in the fourth ventricle adds more CSF.
Step 6: CSF flows out two lateral apertures and one medial aperture.
Step 7: CSF fills subarachnoid space and bathes external surfaces of brain and spinal cord.
Step 8: At arachnoid villi, CSF if reabsorbed into venous blood of dural venous sinuses.

Once the CSF is absorbed into the dural venous sinuses, it becomes part of the blood flow that is drained by the internal jugular veins.

If the internal jugular veins are obstructed and the dural sinuses drain slowly, this may cause congestion of the cerebrospinal fluid as well, which may affect steps 1-7 of the cerebrospinal fluid flow.

When internal jugular vein obstructions are treated, there may be an immediate improvement in cerebospinal fluid flow.

A painfully slow, but educational, neuroanatomy youtube clip about cerebrospinal flow: www.youtube.com/watch?v=PUb8iLgpY8E
Cece
Family Elder
 
Posts: 9018
Joined: Mon Jan 04, 2010 4:00 pm

Advertisement

Re: cerebrospinal fluid flow

Postby Cece » Fri Dec 16, 2011 3:40 pm

The cerebrospinal fluid (CSF) not only provides mechanical protection to the central nervous system, but also acts as a transport medium for nutrients, neuroendocrine substances and for the removal of toxic metabolites, preserving the chemical environment of the brain (Davson et al. 1987). As outlined in the second part of this work (Holman et al. 2010), it is hypothesized that the disruption of CSF flow may be linked to neurodegenerative diseases such as Alzheimer's through disturbed regulation of intracranial pressure, through accumulation of toxic metabolites or through a combination of both (Segal 2000; Stopa et al. 2001; Kivisakk et al. 2003; Silverberg et al. 2003; Abbott 2005; Johanson et al. 2005).

You can read about cerebrospinal fluid here:
http://rsif.royalsocietypublishing.org/ ... .0033.full
and then watch the accompanying '3D visualization of CSF flow velocity vectors in a human subarachnoid space during one cardiac cycle' here:
www.youtube.com/watch?v=mGy55iRHTlg&feature=related

The latter was pretty but not intuitively understandable to me...

We show in the work at hand that there are large spatial variations in the velocity distribution in the cranial SAS that will influence the transport behaviour of toxic metabolites and neuroendocrine and other substances released into the CSF. Assuming there are physiological reasons for these variations, we hypothesize that not all regions of the brain will be affected with the same severity by disrupted CSF flow.

Interesting!
Lots of equations follow, reminiscent of Dr. Tucker's or Dr. Beggs' work....
But skipping ahead:
Large variations in the CSF velocity field indicate substantial spatial differences in transport characteristics. For flow in the third cerebral ventricle, there are indications that the ventricle shape is optimized with regards to substance transport between the pituitary gland and the hypothalamus (Kurtcuoglu et al. 2007b). It is conceivable that, similarly, the flow variations in the SAS reflect an optimization with regards to efficient transport of toxic metabolites and other substances used for communication through the CSF space. This would suggest that different areas of the brain would be affected dissimilarly by a disruption of CSF flow. As an example, a brain region requiring very efficient flushing of toxic metabolites may experience accumulation of waste products that could lead to or accelerate neurodegenerative processes, whereas, in other areas, the disruption may have little to no effect.

Presuming that our IJV obstructions could cause disruption to the cerebrospinal flow, this might affect different areas of the brain differently. Substance transport might be disrupted. Removal of toxic metabolites might be disrupted. In some areas the toxins might accumulate, while in others they might not, with neurodegenerative processes as a result.

So the big question is: what effect, if any, do IJV obstructions have on cerebrospinal flow?
Cece
Family Elder
 
Posts: 9018
Joined: Mon Jan 04, 2010 4:00 pm

Do just IJVs impact CSF flow ??

Postby MarkW » Sat Dec 17, 2011 4:10 am

Cece wrote:
If the internal jugular veins are obstructed and the dural sinuses drain slowly, this may cause congestion of the cerebrospinal fluid as well, which may affect steps 1-7 of the cerebrospinal fluid flow.
When internal jugular vein obstructions are treated, there may be an immediate improvement in cerebospinal fluid flow.

Helpful education about CSF flow, Cece. But serious stenoses in other major veins would form back pressure in the IJVs and still reduce CSF flow. The plumber approach of dealing with all major stenoses is most likely to produce improvements in CSF flow. Remember Dr S's post on Nutcracker syndrome: Treating a major vein in the trunk produced improvements not seen when only the higher veins were de-stenosed.
Personally I am still on the 'treat symptoms' page on CCSVI: get a diagnosis of all major veins and treat all stenoses discovered. Just looking at the IJVs and Azygous probably accounts for over 80% of stenoses but I had stenoses in other major veins. We both needed two procedures to find and treat all diagnosable stenoses. I am hoping most pwMS only need one in the future. This is why I started the 'gold standard diagnosis' thread.
Kind regards,
MarkW
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
User avatar
MarkW
Family Elder
 
Posts: 1151
Joined: Thu Oct 19, 2006 3:00 pm
Location: Oxfordshire, England

Re: cerebrospinal fluid flow

Postby Cece » Thu Feb 07, 2013 10:10 am

Cece wrote:If the internal jugular veins are obstructed and the dural sinuses drain slowly, this may cause congestion of the cerebrospinal fluid as well, which may affect steps 1-7 of the cerebrospinal fluid flow.

When internal jugular vein obstructions are treated, there may be an immediate improvement in cerebospinal fluid flow.

This part was from me, not from the links. Before that it was factual but this part needs proving. Evidence based medicine takes forever.
Cece
Family Elder
 
Posts: 9018
Joined: Mon Jan 04, 2010 4:00 pm

Re: cerebrospinal fluid flow

Postby Robnl » Thu Feb 07, 2013 11:41 am

Cece wrote:
Cece wrote:If the internal jugular veins are obstructed and the dural sinuses drain slowly, this may cause congestion of the cerebrospinal fluid as well, which may affect steps 1-7 of the cerebrospinal fluid flow.

When internal jugular vein obstructions are treated, there may be an immediate improvement in cerebospinal fluid flow.

This part was from me, not from the links. Before that it was factual but this part needs proving. Evidence based medicine takes forever.


There is a BNAC study that shows CSF improvement after 6 months post treatment.....all patients...100%
User avatar
Robnl
Family Elder
 
Posts: 429
Joined: Sun Nov 08, 2009 4:00 pm

Re: cerebrospinal fluid flow

Postby Cece » Thu Feb 07, 2013 1:48 pm

I don't remember that one. I'll look for it, thanks.
Cece
Family Elder
 
Posts: 9018
Joined: Mon Jan 04, 2010 4:00 pm

Re: cerebrospinal fluid flow

Postby EJC » Thu Feb 07, 2013 3:41 pm

Cece wrote:
A painfully slow, but educational, neuroanatomy youtube clip about cerebrospinal flow: http://www.youtube.com/watch?v=PUb8iLgpY8E


Thanks for finding this cece, the video, whilst a little cringeworthy, actually explained this very well indeed.

It just seems so logical that problems with fluid flow (of all fluids) could be causing such a vast array of symptoms.

In my non medical mind, surely the poor flow of CSF, the fluid that is responsible for waste disposal of matter in and around the brain, could be the very thing that is leaving "deposits" of material where they aren't meant to be, triggering an autoimmune response - leading to lesions? Is

Is that so far fetched?
User avatar
EJC
Family Elder
 
Posts: 616
Joined: Tue Apr 20, 2010 3:00 pm
Location: Surrey, UK

Re: cerebrospinal fluid flow

Postby Robnl » Fri Feb 08, 2013 4:28 am

Cece wrote:I don't remember that one. I'll look for it, thanks.


http://www.facebook.com/notes/ccsvi-in- ... 4373312211

at your service :wink:
User avatar
Robnl
Family Elder
 
Posts: 429
Joined: Sun Nov 08, 2009 4:00 pm

Re: cerebrospinal fluid flow

Postby Cece » Fri Feb 08, 2013 8:40 am

Much appreciated. :smile:
Everyone in Dr. Zivadinov's study had improvement in cerebrospinal fluid flow and velocity. It was a lasting improvement six months later.
This would need to be duplicated in another study. So interesting. And measurable!

I wonder if cerebrospinal fluid flow has even been studied enough that there are velocities that are defined as abnormal due to slowness? It is better to show that our CSF flow goes from abnormal to normal, than if it goes from normal to normal.
Cece
Family Elder
 
Posts: 9018
Joined: Mon Jan 04, 2010 4:00 pm

Re: cerebrospinal fluid flow

Postby Cece » Fri Feb 08, 2013 10:37 am

EJC wrote:In my non medical mind, surely the poor flow of CSF, the fluid that is responsible for waste disposal of matter in and around the brain, could be the very thing that is leaving "deposits" of material where they aren't meant to be, triggering an autoimmune response - leading to lesions? Is

Is that so far fetched?

Seems reasonable to me.
Theories for lesion formation:
1) autoimmune attack / standard MS explanation
2) "back jets" when neck muscles tighten sending obstructed flow back up forcefully into the brain especially through enlargened emissary veins that allow more direct access for the damaging back jets
3) hypoxia leads to dying neurons lead to immune system clean-up leads to lesion formation
4) impaired CSF leads to toxic build-up leads to immune response leads to lesions
5) leaky blood-brain barrier lets too many toxins/tcells into brain leads to attack leads to lesions
Cece
Family Elder
 
Posts: 9018
Joined: Mon Jan 04, 2010 4:00 pm

Re: cerebrospinal fluid flow

Postby 1eye » Fri Feb 08, 2013 10:39 am

I know this question is not about CSF, directly, but is there an average velocity of venous blood, say in the jugulars, if everything is working? Can't Doppeler measure it? Wouldn't an outlying number indicate something is wrong?
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
Patients sans/without patience
User avatar
1eye
Family Elder
 
Posts: 2920
Joined: Wed Mar 17, 2010 4:00 pm
Location: Kanata, Ontario, Canada

Re: cerebrospinal fluid flow

Postby Cece » Sun Mar 31, 2013 2:06 pm

1eye wrote:I know this question is not about CSF, directly, but is there an average velocity of venous blood, say in the jugulars, if everything is working? Can't Doppeler measure it? Wouldn't an outlying number indicate something is wrong?

You would think so. My then-untreated right jugular had abnormally high velocity, as measured in my first ultrasound back in Oct 2010.
Maybe ask in Dr. Sclafani's thread?

I found flow data, but not velocity data: http://www.nature.com/jcbfm/journal/v29 ... gure-title
what is the difference bet flow & velocity: http://www.cvphysiology.com/Hemodynamics/H013.htm
Cece
Family Elder
 
Posts: 9018
Joined: Mon Jan 04, 2010 4:00 pm

Re: cerebrospinal fluid flow

Postby Cece » Mon Apr 01, 2013 6:36 pm

Is there no thread on the BNAC CSF fluid study? There must be.
I was looking for neurology research to see what effect slowed cerebrospinal fluid flow has on the brain. I found this.
Flow rate of cerebrospinal fluid (CSF) — A concept common to normal blood-CSF barrier function and to dysfunction in neurological diseases

Hansotto Reiber∗
Neurochemisches Labor, Universität Göttingen, Robert-Koch-Straβe 40, D-3400 Göttingen, Germany

Abstract
Many neurological diseases are accompanied by increased protein concentrations in the cerebrospinal fluid (CSF), described as a blood-CSF barrier dysfunction. The earlier interpretation as a “leakage” of the blood-CSF barrier for serum proteins could be revised by introduction of a “population variation coefficient” of the CSF / serum quotients for IgG, IgA and IgM (ΔQ/Q̄) which is evaluated as a function of increasing albumin quotients (QAlb). The data presented here are based on specimens from 4380 neurological patients. These population variation coefficients were found to be constant over two orders of magnitude of normal and pathological CSF protein concentrations (QAlb = 1.6 · 10−3 - 150 · 10−3). This constancy indicates that there was no change in blood-CSF barrier related structures with respect to diffusion controlled protein transfer from blood into CSF and hence no change in molecular size dependent selectivity. The pathological increase of plasma protein concentrations in CSF in neurological diseases could also be explained quantitatively by a decrease of CSF flow rate due to its bifunctional influence on CSF protein concentration: reduced volume exchange, and as newly stated, increased molecular net flux into CSF without change of permeability coefficients. Again, on the basis of a changing CSF flow rate, the hyperbolic functions, which describe empirically the changing quotient ratios between proteins of different size (e.g. QIgG : QAlb) with increasing CSF protein content (QAlb) can likewise be derived from the laws of diffusion as the physiologically relevant description. The hyperbolic discrimination line between brain-derived and blood-derived protein fractions in CSF in the quotient diagrams for CSF diagnosis can be further improved on the basis of the large number of cases investigated. Other physiological and pathological aspects, such as high CSF protein values in the normal newborn, in spinal blockade, in meningeal inflammatory processes, CNS leukemia or polyradiculitis as well as animal species dependent variations can each be interpreted as due to a difference or change in the CSF flow rate.

Decreased cerebrospinal fluid flow can lead to pathological increase in plasma protein concentrations in the cerebrospinal fluid.
The BNAC trial showed that the cerebrospinal fluid flow rate increased after ccsvi venoplasty. Venoplasty might then be expected to lead to a decrease in plasma protein concentrations in the cerebrospinal fluid.

I would need to check googlescholar to see if
1) there is indeed an increase in plasma protein concentrations in CSF in MS (this article stated that there was this increase in neurological disease in general)
and 2) what sequellae might follow from this increase in plasma protein concentration in CSF (is it harmful to the brain)
Cece
Family Elder
 
Posts: 9018
Joined: Mon Jan 04, 2010 4:00 pm


Return to Chronic Cerebrospinal Venous Insufficiency (CCSVI)

 


  • Related topics
    Replies
    Views
    Last post

Who is online

Users browsing this forum: No registered users


Contact us | Terms of Service