Could it work the opposite way? Norm CSF p/v => >blood flow

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

Could it work the opposite way? Norm CSF p/v => >blood flow

Postby Anonymoose » Sun May 19, 2013 1:28 pm

http://www.ajnr.org/content/22/1/196.full
To the best of our knowledge, there have been no reports illustrating normalization of the sizes of cerebral veins and dural sinuses after decreasing CSF pressure in patients with IIH. Gideon et al (8) and Mattle et al (9), by means of MR flow measurement, showed mean blood flows in the superior sagittal sinus of 457 mL/min and 420 mL/min, respectively, in healthy control volunteers and also showed a tendency toward a lower mean flow volume in the superior sagittal sinus (mean, 345 mL/min) in patients with IIH than in control volunteers (8). The flow volume in the superior sagittal sinus in the present patient was low at the time of admission and increased to within normal range, probably because of resolution of the intracranial hypertension. On the other hand, MR imaging in cases of spontaneous intracranial hypotension may reflect an increase in the venous volume throughout the brain, which shows diffuse dural enhancement, prominent dural sinuses, and an engorged epidural venous plexus, with a return to normal appearance with elevation of CSF pressure (10, 11). Fishman and Dillon (10) speculated that the changes were a consequence of the Monro-Kellie rule (10, 12), which states that CSF volume fluctuates reciprocally with changes in intracranial blood volume. We also speculate that normalization in the sizes of cerebral sinuses and veins and in the flow volume of the superior sagittal sinus after normalization of CSF pressure are a consequence of reductions in CSF volume and pressure.

I've read other papers indicating that reducing CSF pressure can cause twisted tortuous cerebral veins to normalize. I'll post them later if I can find them again. (Should really stop reading on my phone)

Above linked paper is an interesting read. It speaks of fluctuating csf pressure. This could make iih diagnosis difficult. Also, some iih mris show white matter lesions in the same areas as MS lesions. In light this and of recent official link between ccsvi, ms, and csf flow/pressure by zamboni, I wonder if MS isn't subclinical fluctuating iihyper/hypotension in rr phase and subclinical constant iihyper/hypotension in progressive forms.

Some cases might be caused by stenosis/valve issues, others caused by muscle, bone, or csf production abnormalities. Different treatments for different causes of the same thing??
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Re: Could it work the opposite way? Norm CSF p/v => >blood

Postby frodo » Sat Jun 01, 2013 1:15 pm

It is an interesting idea. For sure, high CSF pressure is not the cause in every patient, but it could be the cause in some.
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Re: Could it work the opposite way? Norm CSF p/v => >blood

Postby 1eye » Sat Jun 01, 2013 3:49 pm

There is only one source, normally, of pressure in the brain and that is the heart muscle. If the Monroe-Kellie rule holds, as the heart pumps new blood into the brain, either the volume of venous blood or the volume of CSF must decrease. If there is not an identical decrease in those combined volumes, brain matter (if compliant enough) will compress on each heart pulse. The compliance of endothelium and other vein wall matter might morph, and even become tortuous, if there is a long-standing venous hypertension. Might this also explain periventricular lesions? The location seems to be at a place where venous pressure meets CSF pressure.
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