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Thanks, Dr. Sclafani. That works for me. (I would ask how CSF can drain so quickly but talk of CSF makes my head hurt, so I won't. I might ask how a venous malformation in that area could cause symptoms mimicking MS too but I already feel guilty for making you squirm with the first question, so I won't. )

I do love theories though...they can always be tested and proved/disproved.

Thanks again, Dr. Sclafani. You're the bomb!

drsclafani wrote:
my own sense is that cranial nerve and hypothalamic compression is more likely the culprit here. Increases in cerebrospinal pressure probably related to venous outflow reduction's negative effect on cerebrospinal flud drainage causes some minimal increases in pressure in the CSF and downward movement of the brainstem toward the foramen magnum. I think that the compression of the brain stem at the foramen magnum is subtle but may be significant. I certainly have an easier time accepting nearly instantaneous improvements explained by improved CSF drainage than effects on the Vagus nerve.


Not definitive but my sense of things.

S

Cranial nerve compression (or relief of) is a logical explanation for the instantaneous eyesight improvements reported in many patients (including my wife).

As a result of your post above it prompted me to read as much as I could about CSF and it's flow. Which, as usual has left me with far more questions than answers.

This is where Dr Amir's theories start to coincide with your possible theories about the importance of CSF flow.

Do we currently (medically speaking) completely understand the flow mechanisms of CSF? The reading I've done this evening seemed to contain lots of "Mays" and "Possiblies" when discussing routes of flow for CSF.



The following is a cut and past from that oracle of the interweb, Wiki, explaining in language I mostly understand what CSF is and what it does.

CSF serves four primary purposes:

Buoyancy: The actual mass of the human brain is about 1400 grams; however, the net weight of the brain suspended in the CSF is equivalent to a mass of 25 grams. The brain therefore exists in neutral buoyancy, which allows the brain to maintain its density without being impaired by its own weight, which would cut off blood supply and kill neurons in the lower sections without CSF.

Protection: CSF protects the brain tissue from injury when jolted or hit. In certain situations such as auto accidents or sports injuries, the CSF cannot protect the brain from forced contact with the skull case, causing hemorrhaging, brain damage, and sometimes death.

Chemical stability: CSF flows throughout the inner ventricular system in the brain and is absorbed back into the bloodstream, rinsing the metabolic waste from the central nervous system through the blood–brain barrier. This allows for homeostatic regulation of the distribution of neuroendocrine factors, to which slight changes can cause problems or damage to the nervous system. For example, high glycine concentration disrupts temperature and blood pressure control, and high CSF pH causes dizziness and syncope. To use Davson's term, the CSF has a "sink action" by which the various substances formed in the nervous tissue during its metabolic activity diffuse rapidly into the CSF and are thus removed into the bloodstream as CSF is absorbed.

Prevention of brain ischemia: The prevention of brain ischemia is made by decreasing the amount of CSF in the limited space inside the skull. This decreases total intracranial pressure and facilitates blood perfusion.


Questions:-

Is it possible that treating CCSVI is actually about promoting better CSF flow rather than just bloodflow?

Is it possible that skeletal misalignment correction (atlas correction etc) is promoting better CSF flow?

This would explain at least some of what appear to be similar improvements generated by these different approaches.

Then logically, getting your skeletal alignment straight and being treated for CCSVI might be required in some, but not all patients?

Or have I put 2 & 2 together and got 10 again? Which is something I seem to have a habit of doing.

EJC wrote:

drsclafani wrote:
my own sense is that cranial nerve and hypothalamic compression is more likely the culprit here. Increases in cerebrospinal pressure probably related to venous outflow reduction's negative effect on cerebrospinal flud drainage causes some minimal increases in pressure in the CSF and downward movement of the brainstem toward the foramen magnum. I think that the compression of the brain stem at the foramen magnum is subtle but may be significant. I certainly have an easier time accepting nearly instantaneous improvements explained by improved CSF drainage than effects on the Vagus nerve.


Not definitive but my sense of things.

S

Cranial nerve compression (or relief of) is a logical explanation for the instantaneous eyesight improvements reported in many patients (including my wife).

As a result of your post above it prompted me to read as much as I could about CSF and it's flow. Which, as usual has left me with far more questions than answers.

This is where Dr Amir's theories start to coincide with your possible theories about the importance of CSF flow.

Do we currently (medically speaking) completely understand the flow mechanisms of CSF? The reading I've done this evening seemed to contain lots of "Mays" and "Possiblies" when discussing routes of flow for CSF.



The following is a cut and past from that oracle of the interweb, Wiki, explaining in language I mostly understand what CSF is and what it does.

CSF serves four primary purposes:

Buoyancy: The actual mass of the human brain is about 1400 grams; however, the net weight of the brain suspended in the CSF is equivalent to a mass of 25 grams. The brain therefore exists in neutral buoyancy, which allows the brain to maintain its density without being impaired by its own weight, which would cut off blood supply and kill neurons in the lower sections without CSF.

Protection: CSF protects the brain tissue from injury when jolted or hit. In certain situations such as auto accidents or sports injuries, the CSF cannot protect the brain from forced contact with the skull case, causing hemorrhaging, brain damage, and sometimes death.

Chemical stability: CSF flows throughout the inner ventricular system in the brain and is absorbed back into the bloodstream, rinsing the metabolic waste from the central nervous system through the blood–brain barrier. This allows for homeostatic regulation of the distribution of neuroendocrine factors, to which slight changes can cause problems or damage to the nervous system. For example, high glycine concentration disrupts temperature and blood pressure control, and high CSF pH causes dizziness and syncope. To use Davson's term, the CSF has a "sink action" by which the various substances formed in the nervous tissue during its metabolic activity diffuse rapidly into the CSF and are thus removed into the bloodstream as CSF is absorbed.

Prevention of brain ischemia: The prevention of brain ischemia is made by decreasing the amount of CSF in the limited space inside the skull. This decreases total intracranial pressure and facilitates blood perfusion.


Questions:-

Is it possible that treating CCSVI is actually about promoting better CSF flow rather than just bloodflow?

Is it possible that skeletal misalignment correction (atlas correction etc) is promoting better CSF flow?

This would explain at least some of what appear to be similar improvements generated by these different approaches.

Then logically, getting your skeletal alignment straight and being treated for CCSVI might be required in some, but not all patients?

Or have I put 2 & 2 together and got 10 again? Which is something I seem to have a habit of doing.

my first suggestion would be to review my Downstate lectures by Dr Beggs on Youtube. he speaks well on this issue
another value of csf is its ability to dampen the high pressure pulsatile flow of the carotid inflow into a more stable flow.

i cannot speak for alignment issues. it is not my expertise. improving venous outflow will improve inflow perfusion of the brain and will improve cerebrospinal drainage./

Anonymoose wrote:Thanks, Dr. Sclafani. That works for me. (I would ask how CSF can drain so quickly but talk of CSF makes my head hurt, so I won't. I might ask how a venous malformation in that area could cause symptoms mimicking MS too but I already feel guilty for making you squirm with the first question, so I won't. )

I do love theories though...they can always be tested and proved/disproved.

Thanks again, Dr. Sclafani. You're the bomb!

venous malformations increase venous ouflow volume
how they cause symptoms similar to MS is conjecture. but remember ms causes many symptoms that mimic other diseases.

Dr Sclafani, I have followed your thread through the years, and have watched as your understanding of CCSVI increases and your treatment also changes accordingly.

You treated me over a year ago now, I have been wondering if you have kept some kind of log, apart from this 7500+ posts thread, a history of what you have added / changed in your treatment over time (specifically in the last 12 months)? I was hoping to see how possibly you would have investigated / treated me any differently now, as opposed to when you last saw me just over 12 months ago?

Hi Doc,

What do i read? A workshop on SIR 2013 about CCSVI?


Rgds

Robert

drsclafani wrote:my first suggestion would be to review my Downstate lectures by Dr Beggs on Youtube. he speaks well on this issue

Clive Beggs, MD [CCSVI and Fluid Dynamics of CSF

Clive Beggs, MD [Venous Hemodynamics in CCSVI and MS

Keeping away from theories...

Do veins in the brain have the same elasticity as the jugulars? An MRI shows the left IJV to be greatly dilated in relation to the right IJV when the left innominate vein is compressed. Does IJV compression or occlusion have a similar affect on upstream veins?

Thank you for your patience, time, and responses.

PS Please don't forget to take care of yourself. Do you ever allow yourself a good, long, relaxing vacation?

That was one of the best case studies we've been shown. Multiple images from multiple procedures.

drsclafani wrote:In Spring 2010 she became the second patient of an early adopter of interventional treatment of ccssvi

It doesn't seem good to be among a doctor's first patients. Learning curve.

Thanks Cece for finding the Begg's tapes, I was going to be cheeky and ask you and you must have heard my brain ticking! ;)

Anonymoose wrote:Keeping away from theories...

Do veins in the brain have the same elasticity as the jugulars? An MRI shows the left IJV to be greatly dilated in relation to the right IJV when the left innominate vein is compressed. Does IJV compression or occlusion have a similar affect on upstream veins?

Thank you for your patience, time, and responses.

PS Please don't forget to take care of yourself. Do you ever allow yourself a good, long, relaxing vacation?

the main veins in question are the dural sinuses. these are channels of venous blood that are encased within the dura matter and thus are not as compliant (able to change shape and size) as the jugular veins.

according to the Schelling theory, obstructed veins dilate. when they are compressed, back jets reflux into the deep veins of the brain and cuase trouble. Occlusion or stenosis of the ijv does not result in dilation of the dural sinuses because there is reflux not only into deep cerebral veins but into emissary veins, the other dural sinuses, etc.

Cece wrote:That was one of the best case studies we've been shown. Multiple images from multiple procedures.

drsclafani wrote:In Spring 2010 she became the second patient of an early adopter of interventional treatment of ccssvi

It doesn't seem good to be among a doctor's first patients. Learning curve.

actually it is not good. My first case took four procedures and three locations to finally identify the lesions.

i am afraid to look back to the beginning of this thread. I fear what i have said. Thankfully, most patients have been supportive of the work in progress that this has been. I continue to lose sleep over my early problems and failures. There are many times i wish for a do-over

drsclafani wrote:the main veins in question are the dural sinuses. these are channels of venous blood that are encased within the dura matter and thus are not as compliant (able to change shape and size) as the jugular veins.

according to the Schelling theory, obstructed veins dilate. when they are compressed, back jets reflux into the deep veins of the brain and cuase trouble. Occlusion or stenosis of the ijv does not result in dilation of the dural sinuses because there is reflux not only into deep cerebral veins but into emissary veins, the other dural sinuses, etc.

Well, there goes my theory. Thank you! It's a relief not to wonder.

I wish I could return the favor and relieve you of your regrets. You don't deserve to suffer for doing all you can to help people. Sadly, all I can do is wish you peace and joy and hope the forces that be are listening. I will fervently do so.

Anonymoose wrote:

drsclafani wrote:the main veins in question are the dural sinuses. these are channels of venous blood that are encased within the dura matter and thus are not as compliant (able to change shape and size) as the jugular veins.

according to the Schelling theory, obstructed veins dilate. when they are compressed, back jets reflux into the deep veins of the brain and cuase trouble. Occlusion or stenosis of the ijv does not result in dilation of the dural sinuses because there is reflux not only into deep cerebral veins but into emissary veins, the other dural sinuses, etc.

Well, there goes my theory. Thank you! It's a relief not to wonder.

I wish I could return the favor and relieve you of your regrets. You don't deserve to suffer for doing all you can to help people. Sadly, all I can do is wish you peace and joy and hope the forces that be are listening. I will fervently do so.

thanks
it means a lot to me

drsclafani wrote:

Cece wrote:That was one of the best case studies we've been shown. Multiple images from multiple procedures.

drsclafani wrote:In Spring 2010 she became the second patient of an early adopter of interventional treatment of ccssvi

It doesn't seem good to be among a doctor's first patients. Learning curve.

actually it is not good. My first case took four procedures and three locations to finally identify the lesions.

i am afraid to look back to the beginning of this thread. I fear what i have said. Thankfully, most patients have been supportive of the work in progress that this has been. I continue to lose sleep over my early problems and failures. There are many times i wish for a do-over

The burden of each exploring human?

What if you did not start with the knowledge you had a few years ago??
You did the right thing....no doubt about that. as a patient you have a choice...i also was treated early 2010 when no many patients were treated at Euromedic (dr Simka)
Yes, treatment is much better now...but if i had not done it, would I be here???

Keep up the good work, you got the best treatment at this moment (and i got experience with 4 pta's in 4 different clinics )

Rgds,

Robert