This Is MS Multiple Sclerosis Knowledge & Support Community

Dr F I would like to learn about the left versus right jugular flows,
it is said in the articles that the left is the 'dominant' flow and if that is impeded the right side takes most of the flow. That statement alone has so many alternative possibles such as collateral development. My understanding of the total skull flow has me thinking that if this occurs there will be regions of the brain at risk of poor flows. The risks will vary and change over time as the body developes both the problem and the solutions. The de-generative effect can happen over a life time and compensations happen from conception and birth!
(Your comment about developing a 3D viewing is very promising, the 1D views we have now have coloured thinking and it shows in the literature when I consider the thinking that has brought together points of view on issues, have you meet Mark Haacke as yet?)

If that is the case because of the complexity of the flow system through the brain and skull before exiting it would create a myriad of possible side effects.
To 'assume' that there would be an outcome common to 'one issue, on one side, in one pipe' of the drainage system would be 'risky'.
As I read more about the complexity of diseases and syndromes I realise that there are many, many possible scenarios happening before a disease is defined. The assumption that Dysautonomia is fundamentally a single jugular caused disease is a very good example.

Nothing in Human Health understanding is simple!

Regards,
Nigel

Nigel,
There are different design variations in the dural sinuses that lead to the internal jugulars and VVP. In most people the superior and inferior sagittal sinus meet at point called the confluence of sinuses or the torcula, which is in front of the knowledge bone inside the cranial vault. Some people have no confluence. Instead, the superior sagittal sinuse drains into the right dural sinuses and internal jugular and the inferior sagittal and straight sinus drain into the left dural sinuses and internal jugular. In other people one part or another is missing or undersized. There are other variations as well. As far as which side is dominant, I have a skull with craniosynostosis where the sutures on the left side closed too soon and the internal jugular is small and partially blocked by the petrous portion of the temporal bone which contains the nerves and component of the ear. It is also part of the internal carotid siphon entry to the brain. As you suggested, the right dural sinuses and internal jugular have compensated for the decrease in outflow on the left side and they are extra large. The signs and symptoms a person experience depend on where the fluid and pressure accumulate which is very much effected by an individual's design of the cranial vault and the brain.

Nothing in nature is simple and the human brain is by far the most complicated of all things in nature.

Dr Flanagan I have been taking Diamox for 5 days. It has been beneficial for me. No longer hot in the brain. I have been able to get off the toilet on my own. Everything is just easier to do. I was wondering is there anything I can take/eat that suppresses manufacturing of CSF? Is there anything I should avoid ingesting?

Dania,
Pomegranates have similar chemical agents and action to Diamox. Ask your pharmacist about supplements. You could also try the juice but it will be less concentrated and probably adulterated. In contrast to suppressing production, surgeons sometimes use hypertonic solutions to move CSF following traumatic brain injuries. I will be discussing hypertonic solutions in my next book. There is an ongoing debate as to whether or not coffee increases CSF production. Some doctors recommend it to make up for losses following spinal taps. I would think however that if it increases producion in your case it would most likely cause headaches. If not, it's probably not a problem.

dania, glad to hear you are getting some relief.

I forgot to mention that I no longer have tachycardia since taking Diamox. YEAH! Pulse is normal again. And my brain is still not hot.And I am less miserable.

That's terrific Dania. Keep me posted.

I look forward to what you find on my Fonar MRI.

I’m catching up on my TIMS reading and note two posts on 12/3/12 from NZer1 and Uprightdoc that I would like to clarify.

NZer1: "Any news from the Damadian/Rosa studies though Dr F?"

Clarification: The csf study referred to is strictly Dr. Scott Rosa's research. Dr. Damadian deserves high praise for inventing the Fonar upright MRI. Dr. Rosa uses that valuable equipment in his research. Dr. Damadian also refers patients to Dr. Rosa for research and treatment as do a number of other doctors. However, Dr. Damadian is not part of the research design and implementation, patient treatment or publication of Dr. Rosa's study. This research evolved solely from Dr. Rosa's 25 years of trauma research prior to meeting Dr. Damadian.

Uprightdoc: "There is nothing new that I know about. It will take a long time if they are the only ones doing upright studies. Hopefully, more researchers will get involved. All they have to do is repeat the studies that have been done in the recumbent position."

Clarification: Yes, valid research done well takes time. Dr. Rosa is in the process of analyzing data with publication planned in 2013.
As far as repeating studies done in the recumbent position, Dr. Rosa tells me that is not the goal of his study. He states that he “is using a unique image-guided process to determine adjustment specifications based on a combination of AO x-rays and upright MRIs with a newly developed coil and software that provides more information than previously available.”
Dr. Rosa states, “Every subject in the study has an upright image upon arrival, an image-guided AO adjustment followed by a post-image to determine any change. The patients that received a sham treatment were then brought back and given a real treatment with follow up csf flow study.”
Tamarack

You misunderstood my comment and took it out of context. The question by Nigel as I understood it was simply asking if there was any new news regarding Dr. Rosa's study. The second part of the reply wasn't referring to the Rosa study which is being done in the upright position. Instead, I was referring to the many computer modeling studies I have been writing about on my wordpress blog as well as on this thread. There have been many terrific computer modeling studies done over many years by radiologists, engineers, physicists and mathematicians. They are starting to recognize the important role of the spinal canal in modulating CSF volume and pressure in the brain. The problem is they have all been done in the recumbent position and upright posture changes everything.

Research does take time but taking time doesn't make research valid. A great deal of time and money was spent doing valid research that proved there is no connection between MS and trauma. Those findings are now in question. The research could be sped up significanty if everyone was on the same page and studying the different aspects of the problem. Solutions don't have to wait for the research to catch up either. Some solutions have a great deal of biological plausibility and low morbidity and can be instituted immediately. Higher risk procedures require more research.

dr. flanagan, again you added your knowledge, expertee and very good "common sence" and i 100 per cent agree.

i quote you:

Research does take time but taking time doesn't make research valid. A great deal of time and money was spent doing valid research that proved there is no connection between MS and trauma. Those findings are now in question. The research could be sped up significanty if everyone was on the same page and studying the different aspects of the problem. Solutions don't have to wait for the research to catch up either. Some solutions have a great deal of biological plausibility and low morbidity and can be instituted immediately. Higher risk procedures require more research

I just recently heard from CostumeNational. He is doing much better. CostumeNational is a young man who was in a motorcycle accident ten years ago. He was going downhill fast when I met him about two years ago. Fortunately he was caught in time and successfullly treated by by Dr. Michael Koontz in Greece using Kale Specific Upper Cervical, which is an excellent technique. A couple of months ago I got a reply on my blog from Twistedsister who is also doing much better. Twistedsister was successfully treated by Dr. Heidi Grant in the UK using NUCCA specific upper cervical. There are many other cases that have been successfully treated despite the lacking and lagging research. It would have made no sense for Costumenational or Twistedsister to wait and continue to degenerate until Dr. Rosa's study is complete and he has time to train other doctors all over the US and around the world. That will take years. Patients with serious neurological problems can't afford to wait that long. Furthermore, his study doesn't include other equally effective upper cervical methods or methods used to treat the lower spine. Nor does his study prove that his method is superior and gets better results. His study does show the effect of upper cervical misalignments on blood and CSF flow. It also shows that specific scans of the craniocervical junction are more accurate at determining misalignments and connective tissue injuries. Lastly his study shows that correction of the upper cervical spine can improve blood and CSF flow in the brain. There needs to be a lot more upright MRI studies done using different methods of correction of the craniocervical junction. We also need studies on the role of spondylosis, scoliosis and stenosis in the lower spine in neurodegenerative diseases, as well as studies on the best manual and surgical methods to correct the lower spine.

Thanks Blossom. It's people like you with common sense that get it.

From the Land down Under! Our Western Island!

Journal of Neurosurgery: Pediatrics
Posted online on November 23, 2012.
ARTICLE
The role of venous sinus outflow obstruction in pediatric idiopathic intracranial hypertension
Clinical article
Christopher M. Dwyer, M.B.B.S.1, Kristina Prelog, M.B.B.S.2, and Brian K. Owler, F.R.A.C.S.1,3
1T.Y. Nelson Department of Neurology & Neurosurgery and 2Department of Medical Imaging, Children's Hospital at Westmead; and 3Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, New South Wales, Australia
Abbreviations used in this paper: ICD = International Classification of Diseases; IIH = idiopathic intracranial hypertension; LP = lumbar puncture.
Address correspondence to: Christopher M. Dwyer, M.B.B.S., T.Y. Nelson Department of Neurology & Neurosurgery, Children's Hospital at Westmead, Hawkesbury Road, Westmead, NSW 2145, Australia. email: cdwy0142@uni.sydney.edu.au.
Please include this information when citing this paper: published online November 23, 2012; DOI: 10.3171/2012.10.PEDS1299.

Related Articles

By Keywords:
idiopathic
intracranial
hypertension
, venous
sinus
obstruction, magnetic resonance venogram, cerebrospinal fluid opening pressure
Abstract

OBJECT
The authors examined the role of venous sinus obstruction in the etiology of idiopathic intracranial hypertension (IIH) by reviewing more than 200 MR venograms performed in suspected cases of IIH.

METHODS
Individual MR venograms performed in cases of suspected IIH at the Children's Hospital at Westmead in Sydney, Australia, were reviewed. The authors excluded cases in which an intervention was performed before the scan or a structural cause for venous obstruction was identified. Cases with confirmed hydrocephalus were also excluded.

For each of the 145 remaining scans, the authors completed a detailed review on a slice-by-slice basis of the 2D source images used to compile the rendered 3D MR venogram. The anatomical configuration of the dural venous sinuses and any areas of decreased flow in circulation were then noted. Where possible, they correlated their radiological findings with evidence of raised intracranial pressure based on LP opening pressures. They also reviewed a control group of 50 MR venograms.

RESULTS
Seventy-six (52%) of 145 scans showed evidence of venous obstruction in the dominant-side circulation. Substantial nonphysiological collateral circulation was seen in 68% of cases with dominant-sided obstruction, suggesting a process of recanalization. In contrast, in the absence of dominant-sided obstruction, collateral circulation was uncommon.

In 27 cases, CSF opening pressure measurements were available. In 20 cases the opening pressures were in excess of 20 cm H2O. Of those, 17 demonstrated evidence of dominant-sided venous outflow obstruction. Among those cases, the median opening pressure was 34 cm H2O.

Dominant-sided venous outflow obstruction was seen in only 2 of 50 MR venograms in the control group. Furthermore, evidence of collateral circulation was also uncommon in the control group. There was a highly statistically significant difference between rates of dominant-sided venous obstruction in the suspected IIH and control groups (p ≤ 0.001).

CONCLUSIONS
A majority of patients presenting for investigation of suspected IIH demonstrated evidence of dominant-sided venous obstruction on MR venogram. In addition there was a high correlation between elevated CSF opening pressures and dominant-sided venous sinus obstruction. This correlation was further supported by evidence of collateral recanalization in patients with elevated CSF pressures and dominant-sided venous obstruction. A control group of 50 MR venograms indicated that dominant-sided venous outflow obstruction is an unlikely incidental finding, and a highly statistically significant difference was found between rates of obstruction in the suspected IIH and control groups.
http://thejns.org/doi/abs/10.3171/2012. ... HistoryKey&

Dear Dr. Flanagan,
once again I'm asking you for advice.

This week I had an appointment with Dr. Bodo Kuklinski in Rostock/Germany.
Dr. Kuklinski has published numerous articles and 3 books on instable neck joint and its
role in the genesis of other/subsequent diseases, he is also an expert in the field of orthomolecular medicine.

I will post a more detailed report later on, in short he thinks that I have an istable neck joint and
that this is the source of "the sysmptoms called MS by the neurologists" (direct quote Dr. Kuklinski)

He did a breathing gas analysis and found high concentrations of NO in my breathing air, urine and blood sample were
taken (no results yet).

He refered me to two other doctors:
- to Dr.Schulz (Hannover/Germany) for upright MRI (here is the link to their website - http://www.mrt-hannover.de/ - unfortunately only in
german, I couldnt find any specific Ino abot the Upright-MRI there).
I've got an appointment with them for tuesday next week

- to Dr. Müller-Kortkamp (Soltau/Germany) for otoneurological examinations
Apoointment is set for February 2013

He wants Dr.Schulz to make an Upright-MRI of the "Cranio Cervical Junction" (diagnosis: suspected cervico-encephal syndrom),
I showed him my x-rays (the ones that I had posted here at TIMS) but he didnt seem to be concerned about my thoracic spine or the lower spine.

In your opinion, is there anything to be considered regarding the lower parts of my spine for the MRI next tuesday?

Is there kind of a standard-scope for the Upright-MRI?

Thx a lot