Third ventricle of the brain is enlarged in MS

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

Third ventricle of the brain is enlarged in MS

Postby frodo » Thu Sep 12, 2013 1:05 am

It seems that third ventricle of the brain is enlarged in MS. While it fixes quite well in CCSVI theory (venous outflow should produce enlargement of at least one brain area), I find difficult to fix it in an autoimmune model.

Source: http://www.ncbi.nlm.nih.gov/pubmed/24022394


Third ventricular enlargement in early stages of multiple sclerosis is a predictor of motor and neuropsychological deficits: a cross-sectional study.

Abstract
OBJECTIVES:
Whether transcranal sonography (TCS) depicted third ventricular enlargement as a sign of brain atrophy is predictive for neuropsychological deficits in mildly affected patients with multiple sclerosis (MS).
DESIGN:
Cross-sectional study of a cohort of mildly diseased patients with MS.
SETTING:
Neurological MS outpatient clinic at a large teaching hospital in central Europe.
PARTICIPANTS:
Fifty-four patients with MS (16 men, 38 women, mean age 40±10 years, mean disease duration 6±5 years; mean Expanded Disability Status Scale 2±1.3) and 33 healthy controls (12 men, 21 women; 38±11 years) underwent clinical examination, an assessment of the third ventricle width by means of TCS and the Brief Repeatable Battery of Neuropsychological tests for MS, the 25-Feet Foot Walk test, the 9-Hole PEG test, the Beck Depression Inventory and a quantitative fatigue assessment. Statistical analysis was performed with univariate correlation and thereafter by stepwise regression analysis.
RESULTS:
Patients' mean third ventricular width (3.9±1.6 mm) was significantly wider compared to controls (3.4±0.8 mm). Using stepwise regression analysis models with age, MS duration, third ventricle width and quantitative fatigue assessment as baseline variables, an increasing third ventricle width significantly correlated with the target variables worsening of motor deficits (p<0.002), worsening of verbal recall (p<0.04) and of visual spatial recall (p<0.005). Severity of depression and of fatigue was unrelated to third ventricular width.
CONCLUSIONS:
In this cohort of patients with MS with mild disease, third ventricular enlargement was indicative for motor deficits and cognitive impairment, even after considering fatigue as a relevant comorbidity. Third ventricular enlargement by means of TCS seems to be a useful, clinically meaningful parameter to stage patients' disease severity. Follow-up studies must show whether an intraindividual future third ventricular increase indeed signals larger cognitive impairment.
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Re: Third ventricle of the brain is enlarged in MS

Postby 1eye » Thu Sep 12, 2013 9:01 am

Maybe, as in high pressure hydrocephalus, pressure in the ventricle enlarges it and makes the brain look like it is atrophied. Somtimes hydrocephalus victims, after successful treatment, with fully functioning brains, have brains reduced to a thin layer plastered onto the inside of their skulls.
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Re: Third ventricle of the brain is enlarged in MS

Postby cheerleader » Fri Sep 13, 2013 2:35 pm

Hi Frodo--

This enlargement has been noted since MS patients received MRIS. Neuros chalk it up to neurodegeneration--nature abhors a vacuum, so when axons are lost, the brain shrinks and the third ventricle increases in response. But what if it is pseudoatrophy and can be reversed? That's what happened to my husband after venoplasty, and his return to a normal sized third ventricle is documented on MRI. He had some bad positional headaches after treatement (lying down relieved it, just like a lumbar puncture headache), and his treating IR told him it was most likely because his CSF levels were so different, it was as though "his brain was a sponge that had just been wrung out."

To read more on the topic of normal pressure hydrocephalus, the third ventricle and CCSVI--check out this thread. It was started in 2009--and continues to grow.
chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic8147.html


Dr. Eliot Frohman, professor of neurology at Southwestern University- was a moderator and participant in the CCSVI convocation. He consistently had cogent and insightful questions and comments during the day. One of his points has stayed with me, and prompted me to do some more research on cerebrospinal fluid. Dr. Frohman commented that CCSVI was reminding him of his shunting treatment of normal pressure hydrocephalus ...mainly in the fact that the third ventricle was being enlarged in both MS and NPH- Here's his comment-
Quote:
I have seen this happen in “normal pressure hydrocephalus- (NPH) Where there is a loss of gait, cognitive and bladder issues and the lesions disappear because the expanded ventricle swallows the lesion. I have shunted the brains of NPH patients, and they showed remarkable improvements. Again, the enlargement of the third ventricle precedes the changes.
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: Third ventricle of the brain is enlarged in MS

Postby ThisIsMA » Wed Sep 18, 2013 9:59 am

So in cases where the third ventricle is enlarged, wouldn't shunting be helpful? I know nothing about this, was just wondering. One thing that has bothered me about my own past MRI's is that my own ventricles look just HUGE compared to images I see on the web of normal brains. I've wondered about that but my neurologist didn't comment on it, and it didn't occur to me to ask till long after the appointment (when I ordered a CD of my MRI and was looking at it from home). I have the cog fog, fatigue, balance issues,heat intolerance, etc.
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Re: Third ventricle of the brain is enlarged in MS

Postby Cece » Wed Sep 18, 2013 12:51 pm

The neurologist explanation for enlarged third ventricle is that it's because the rest of the brain has atrophied, which has made the ventricle grow. If this is true, then shunting wouldn't help, because the problem is not the enlarged ventricle but the atrophied brain.

If the third ventricle enlargement is due to poor cerebrospinal fluid drainage, as a result of poor venous drainage, then YES shunting could be helpful but the first step would be to correct the venous drainage, since that could correct the impaired CSF drainage and shunting would not be needed. For people whose venous drainage cannot be corrected, because of jugular hypoplasia or occluded jugular veins, then shunting might make a lot of sense.
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Re: Third ventricle of the brain is enlarged in MS

Postby 1eye » Wed Sep 18, 2013 4:27 pm

I think I am having an exacerbation.

My brother got his shunt as a newborn, It was one of the first operations of its type on a newborn, in the early nineteen-sixties. It is not venous drainage that is augmented. CSF is being given more drainage, by shunting it from probably where it originates (a ventricle) directly to the jugular. He has his shunt (which has had to be periodically replaced) right inside his jugular, and it has not been able to stenose because it's made out of plastic.

So his brain has not had to flatten itself against the inside of his skull.

There's nowhere else to go when the ventricle has too much pressure, because too much CSF is being produced to drain it out fast enough.

They have, with shunts, sometimes had the opposite problem to poor drainage. They have had to put a device in the shunt, that doesn't let too much CSF drain out. It's a flow-rate limiting gizmo. I think a shunt or an endoscopic procedure that makes a hole directly in the ventricle wall would help pw"MS". If only... I posted a youtube link a while back that shows the hole-in-the-wall surgery, the way the doctor sees it. There was not much comment that I recall.
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Why is it enlarged?

Postby 1eye » Thu Sep 19, 2013 12:01 pm

ThisIsMA wrote:If the third ventricle enlargement is due to poor cerebrospinal fluid drainage, as a result of poor venous drainage, then YES shunting could be helpful but the first step would be to correct the venous drainage, since that could correct the impaired CSF drainage and shunting would not be needed. For people whose venous drainage cannot be corrected, because of jugular hypoplasia or occluded jugular veins, then shunting might make a lot of sense.
This I would think would be a simple case for a radiologist to determine whether the cause of ventricle enlargement is due to pressure from the CSF or brain shrinkage (does the brain look shrunken?). Especially if you have 2 MRIs separated in time. That would easily fulfill the much-discussed requirement for damage separated in both space and time. Is the apparent atrophy coming from the ventricle pressure or overall loss of volume, and how much of each?

Shunting is a more permanent solution if there is concern about restenosis. But it might be good to have those 2 MRIs to reinforce that decision. Even with only one though, doesn't the brain, like many things, usually increase in size to fill the available space, especially when acted upon by internal pressure? I would have thought that a large amount of increased ventricle volume would have to be pressure, but if you need a definitive answer, who better to ask than a scientifically-minded radiologist with 2 MRIs in his hands? Wait-times being what they are around here, I figure separation in time would not be a problem. :-)
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Re: Third ventricle of the brain is enlarged in MS

Postby civickiller » Fri Sep 20, 2013 9:36 am

my theory that ive had a few years ago with only a few listening is that the ventricles are enlarged because the CSF is being blocked at the c1 level so the CSF backs up in the ventricles enlarging them which is why you see majority scarring around the ventricles in your brain because the ventricle can only hold so much until it leaks out causing the scarring.

the simplest explanation tends to be the right one
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Re: Third ventricle of the brain is enlarged in MS

Postby 1eye » Fri Sep 20, 2013 12:39 pm

civickiller wrote:my theory that ive had a few years ago with only a few listening is that the ventricles are enlarged because the CSF is being blocked at the c1 level so the CSF backs up in the ventricles enlarging them which is why you see majority scarring around the ventricles in your brain because the ventricle can only hold so much until it leaks out causing the scarring.

the simplest explanation tends to be the right one


Yes, if that is what has happened to cause the back-up. Maybe both C1 problems and other causes for new stenosis coincide. I agree, anyway, about the scarring. If you believed that, it might be important to find out, with your pocket-7-Tesla-MR imager, whether the scarred veins were the special ones that feed CSF production, or the ones which merely drain the life-supporting blood supply.

My MS started (not certain about this) after a fall on my backside of about 7 feet when a ladder collapsed over a gravel driveway. Hurt my dignity, and vertebrae might have suffered too, but I also have deformity in my veins. Can't pin down timing of either.

If in fact the filtering of blood components to produce CSF were co-located with lesions, wouldn't that be another kick in the dignity? Clogged filters at the ends of water pipes might cause leaks, and leave rust (iron oxide) smears like that. Maybe the cause (pathogen, environment, or heredity) makes the pressure inside ventricles build up? There is no guarantee it is the same there as it is at other measuring points.

Knowing the sole cause of a problem, if there is only one, or all of them if there are more, can be the beginning of a solution. But you might also find it another way, especially after 100 years of trying.
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Re: Third ventricle of the brain is enlarged in MS

Postby civickiller » Fri Sep 20, 2013 6:38 pm

a few of my symptoms, if you call them MS symptoms, ive had tinnitus as far back as i can remember and my lower back pain started with a fall from a tree when i was around 12. i think the head trauma when i was 2 then a fall when i was 12 started me on the path to MS
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Re: Third ventricle of the brain is enlarged in MS

Postby cheerleader » Fri Sep 20, 2013 7:25 pm

Hi Civic-
You're not alone--Dr.Scott Rosa has been doing some interesting research using FONAR upright MRI and atlas orthogonal treatment. There are most certainly people who have neck/head injuries which impact their CSF flow and might enlarge the third ventricle.
http://www.prweb.com/releases/CSF-Multi ... 929674.htm

reasons for enlarged third ventricle might be obstructed venous flow due to injury, a congenital malformation, traumatic brain injury...lots of causes, all mechanical.
(which is probably why neurology would prefer to say it's just brain atrophy, and nothing that can be addressed.)
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