The superior sagittal sinus drops from about 5- 10 mmHg in the supine position to negative value in the upright position
uprightdoc wrote:Currently NPH is associated with enlargement of the ventricles. The definition is open to debate and I believe that it needs to be changed to include any backup of CSF. For example, CSF can backup in the cisterns without enlargement of the ventricles and cause compression of the brainstem.
The ‘normal pressure’ aspect of NPH is something of a misnomer. While CSF pressure may be within the normal range when measured by manometry at lumbar puncture, continuous CSF pressure measurements reveal waves of increased pressure, particularly during rapid eye movement (REM) sleep, and CSF infusion studies reveal abnormal CSF circulation.
In 13 of 23 patients with multiple sclerosis, studied with computerized tomography (C.T.) the lateral ventricles were found to be enlarged.
Nineteen patients were found to have mildly dilated ventricles and another nine patients had moderate to severe ventricular enlargement. Performance on memory and intelligence testing was related to the degree of ventriculomegaly. Three linear CT measurements were also recorded. [b'Using this method, the width of the third ventricle proved to be the best indicator of intellectual and memory dysfunction. [/b]Measures of cognition and ventricular size did not correlate with length of illness or overall disability as rated by the Kurtzke Disability Status Score.
coach wrote: Any chance that undersized posterior cranial fossa could play a role in this or am I totally missing the mark. I had shared with Dr. Flanagsn that both I and my daughter had postpartum optic neuritis and a sister that had c-sections with her two children had IIH. I didn't have high juglar stenosis but the AZY had a problem along with a couple of low IJV spots. Might that explain the 14 yr hiatus of MS symptoms after birth of first child. Also, some patients after initial improvements (myself included) lose some benefits. In my case walking and balance which never improved and have seem to grow worse.
What differentiates NPH from MS or can one have both?
1eye wrote:The superior sagittal sinus drops from about 5- 10 mmHg in the supine position to negative value in the upright position
Why does that happen?
uprightdoc wrote:Hello Cheerleader,
I have seen many cases with normal size ventricles and excess CSF volume in the cisterns or in the spaces at the top of the brain that are not considered to be NPH.
Whether the ventricles enlarge or not depends on internal versus external ventricular pressures. The worst cases of Alzheimer's are associated with low CSF flow and pressure. If CSF pressure is very low the ventricles won't necessarily enlarge. NPH occurs when CSF backs up regardless of whether the ventricles enlarge or not.
cheerleader wrote: ... Will this excess CSF show up on MRI? What is the quantification? How do we know if this is occurring in an MS brain? Neurologists insist NPH has nothing to do with MS....what is their evidence? What could be our evidence?
uprightdoc wrote:cheerleader wrote: ... Will this excess CSF show up on MRI? What is the quantification? How do we know if this is occurring in an MS brain? Neurologists insist NPH has nothing to do with MS....what is their evidence? What could be our evidence?
Your welcome Cheerleader,
Aside from enlargement of the ventricles called ventriculomegaly, other evidence of NPH also includes enlarged spaces, fissures and sulci in the brain. Further evidence for obstruction to CSF flow is right around the corner in the form of cine upright MRI.
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