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brainstem compression
Posted: Fri Nov 30, 2012 1:39 pm
by Cece
http://www.ncbi.nlm.nih.gov/pubmed/3199003
Changes in the brainstem evoked responses following jugular vein ligation.
Yung MW, Soliman AM.
Department of Otorhinolaryngology, University of Liverpool.
Abstract
Blockage of both jugular veins is often followed by signs of intracranial hypertension. The use of brainstem evoked responses (BSER) in the detection of brainstem compression following jugular vein ligation in guinea pigs was studied. Thirty pigmented guinea pigs were studied. Unilateral jugular vein ligation was performed in 10 animals and bilaterally in 10. Ten animals were controls. The BSER to clicks at 20 db above hearing thresholds before and 6 hours following ligation of one or both jugular veins were recorded. No change in the hearing threshold was observed following jugular vein(s) ligation. However, prolongation of the I-III and III-IV interpeak intervals were observed following both unilateral and bilateral jugular vein ligation. The results suggest that BSER monitoring may be useful in the early detection of brainstem compression following jugular vein ligation in head and neck surgery.
Research was done on rabbits.
If there was cooperation between neurologists and interventional radiologists, research using BSER monitoring could be done before and after venoplasty. It might be possible to show a post-treatment reduction in brainstem compression, if such a reduction occurs. Could it predict who would be most likely to have a 'wow' response to venoplasty?
Re: brainstem compression
Posted: Sat Dec 01, 2012 12:15 pm
by 1eye
Can the brain-stem get compressed during ballooning? Ever since I saw the pictures of the dissected neck and artists renderings of the carotid sheath I've wondered if the vagus gets pinched by the balloon.
Re: brainstem compression
Posted: Sat Dec 01, 2012 1:20 pm
by Cece
Maybe if the ballooning were done high enough? Not if the ballooning is at the usual spot, down at the base of the neck, near the juncture of the jugular and innominate veins.
But relief of brain stem compression is a possible immediate outcome of the procedure. If cerebrospinal fluid flow is compromised due to outflow obstruction, there may be pressure on the brain stem, and relief of that pressure might be why we get some of the immediate improvements including the autonomic nervous system improvements. It was an alternative theory offered by Dr. Sclafani in a different thread.
I could never even theorize as to why my hearing improved mid-procedure until now. The BSER test suggested above is a hearing test since the brainstem is involved with hearing.
Re: brainstem compression
Posted: Sat Dec 01, 2012 2:24 pm
by MarkW
Cece wrote:.....But relief of brain stem compression is a possible immediate outcome of the procedure. If cerebrospinal fluid flow is compromised due to outflow obstruction, there may be pressure on the brain stem, and relief of that pressure might be why we get some of the immediate improvements including the autonomic nervous system improvements. It was an alternative theory offered by Dr. Sclafani in a different thread.
I could never even theorize as to why my hearing improved mid-procedure until now. The BSER test suggested above is a hearing test since the brainstem is involved with hearing.
Hello Cece,
Take a look at the cranial nerves and you could devise an educated guess on your hearing improvements.
Could you please combine this thread with the vagus (de)compression thread as I think they could be two adjacent areas in the jigsaw of CCSVI syndrome.
Kind regards,
MarW
Re: brainstem compression
Posted: Sat Dec 01, 2012 5:50 pm
by Cece
I think it takes a mod to combine threads but it's actually two very different concepts. What Dr. Arata is talking about with the vagus nerve is not a matter of relieving compression. He is saying
The vagus nerve is the conduit for autonomic signals and it travels alongside the jugular vein. Renal denervation therapy has shown us that autonomic fibers can be manipulated via a transvascular approach. If the balloon mechanically stimulated the vagus nerve and it was what lead to the response to treatment it would solve the mystery of how a patient with a normal jugular vein could respond to jugular ballooning.
http://blog.synergyhealthconcepts.com/d ... -magazine/
I interpret this as saying the ballooning squeezes the vagus nerve and that mechanical stimulation is supposed to be enough to cause the improvements seen after CCSVI treatment. Changes in blood flow are not what's causing the improvements, according to this. The compression of the vagus nerve occurs temporarily during the procedure; it was not compressed prior nor afterwards.
The brainstem compression theory is saying that changes in blood flow are important, so much so that it also leads to changes in cerebrospinal fluid flow since CSF drains into the sinuses which drain into the jugulars, and those changes in cerebrospinal fluid flow potentially in some patients relieve brainstem compression. The brainstem was compressed prior to the procedure, and afterwards is not.
There is research on brainstem compression in conditions such as Chiari malformation.
Re: brainstem compression
Posted: Wed Dec 05, 2012 2:35 pm
by MarkW
Cece wrote: What Dr. Arata is talking about with the vagus nerve is not a matter of relieving compression. He is saying
The vagus nerve is the conduit for autonomic signals and it travels alongside the jugular vein. Renal denervation therapy has shown us that autonomic fibers can be manipulated via a transvascular approach. If the balloon mechanically stimulated the vagus nerve and it was what lead to the response to treatment it would solve the mystery of how a patient with a normal jugular vein could respond to jugular ballooning.
http://blog.synergyhealthconcepts.com/d ... -magazine/
I interpret this as saying the ballooning squeezes the vagus nerve and that mechanical stimulation is supposed to be enough to cause the improvements seen after CCSVI treatment. Changes in blood flow are not what's causing the improvements, according to this. The compression of the vagus nerve occurs temporarily during the procedure; it was not compressed prior nor afterwards.
The brainstem compression theory is saying that changes in blood flow are important, so much so that it also leads to changes in cerebrospinal fluid flow since CSF drains into the sinuses which drain into the jugulars, and those changes in cerebrospinal fluid flow potentially in some patients relieve brainstem compression. The brainstem was compressed prior to the procedure, and afterwards is not.
Hello Cece,
I am curious to know what Dr Mike Ararta really means. Does he imply that he is inflating a balloon directly against the vagus nerve ??? My first venoplasty (Athens 2010) was not near my vagus nerve but I noticed rapid autonomic changes. I cannot envisage how ballooning away from the vagus nerve would impact the vagus nerve as veins are elastic (except for valves). I am also curious to know how much brainstem compression might be relieved by venoplasty. My understanding is that CSF pressure is carefully controlled by the body, otherwise brain damage occurs. (CSF flow rates are not the same as CSF pressure).
We need some basic research on what happens after venoplasty but the ethics of measuring CSF pressure around the brainstem during venoplasty is difficult (unless there is an accurate non invasive method).
Some thoughts, not definite information.
Kind regards,
MarkW
Re: brainstem compression
Posted: Wed Dec 05, 2012 4:01 pm
by Cece
Dr. Arata clarified in a conversation over at Facebook that direct stimulation of the vagus nerve was a possibility but only one of the possibilities for how to explain the dysautonomia improvements after venoplasty.
I will need to look at a diagram of where the vagus nerve is. He offers up the observation that patients with normal veins had autonomic improvements when he ballooned regular veins as possible support for the vagus nerve compression theory. Renal denervation has been offered as a comparison but I do not see how it compares.
I made a list another day of possible alternate explanations for why ballooning a normal vein could lead to dysautonomia improvements.
Basic research needed, agreed.
Re: brainstem compression
Posted: Thu Jan 24, 2013 4:19 pm
by Anonymoose
So it doesn't have to be neurovascular contact...it could be brain stem compression (RVLM and all of those nerves that seem to be associated with improvement are in the lower brain stem).
This might explain success with both angioplasty and atlas/dental therapies.
I should quit googling and read more on TIMS.
Thank you Cece. I can now stop obsessing over those dastardly veins.
Re: brainstem compression
Posted: Thu Jan 24, 2013 4:51 pm
by Cece
You've turned up some interesting ideas with your googling, I'd hate to see it stop.
Dr. Arata posts a lot about dysautonomia on Facebook. And you are reading Dr. Sclafani's thread in its entirety? How do you even find time for googling?
Re: brainstem compression
Posted: Fri Jan 25, 2013 6:57 am
by HappyPoet
Cece wrote:He offers up the observation that patients with normal veins had autonomic improvements when he ballooned regular veins as possible support for the vagus nerve compression theory.
Cece, do you know why Dr. Arata would balloon normal veins?
Re: brainstem compression
Posted: Fri Jan 25, 2013 7:35 am
by Anonymoose
Cece wrote:Dr. Arata posts a lot about dysautonomia on Facebook. And you are reading Dr. Sclafani's thread in its entirety? How do you even find time for googling?
I don't do facebook. Could we have a "Cece cuts and pastes Dr. Arata's facebook page" thread? lol I kind of got distracted and took a break from Dr. S's thread. I'll have to get back to that.
Re: brainstem compression
Posted: Fri Jan 25, 2013 9:13 am
by Cece
HappyPoet wrote:Cece wrote:He offers up the observation that patients with normal veins had autonomic improvements when he ballooned regular veins as possible support for the vagus nerve compression theory.
Cece, do you know why Dr. Arata would balloon normal veins?
I don't know why he tried it initially. His observation when he did was that the patient's autonomic nervous system symptoms responded in much the same way as when a stenosis is ballooned. So, now he might balloon a normal vein based on that observation.
Re: brainstem compression
Posted: Fri Jan 25, 2013 9:51 pm
by Cece
Anonymoose wrote: I don't do facebook. Could we have a "Cece cuts and pastes Dr. Arata's facebook page" thread? lol
yes we could
DrArata on Facebook wrote:Dilated veins don't impact nerve function but a 30 atm jugular balloon could impact the vagus.
thoughts
30 atm is a very high pressure balloon. Not sure if this is a typical pressure he is using? For reference my own procedure was done at 8 - 10 atms (I 'd have to check to say for sure). Anything past 18 atm gets me nervous (even if sized correctly).
How does a 30 atm balloon impact the vagus? By referencing the pressure are we back to direct mechanical contact? Could a 20 atm jugular balloon impact the vagus? 10 atm? 6 atm?
"Dilated veins don't impact nerve function" - disagree. The theory for why colors keep leaping out at me is due to relief of venous congestion of the optic nerve after a jugular was dilated. This was an immediate improvement. It was not an autonomic nervous system improvement although I had those too.
I appreciate Dr. Arata sharing his thoughts on CCSVI and dysautonomia. I hope the examination of the ideas comes across with the respect that is intended.
Re: brainstem compression
Posted: Sat Jan 26, 2013 6:35 am
by Anonymoose
I don't see how a one touch stimulation of the vagus nerve would render lasting results.
Could it be that using that mega burst of pressure joggles the veins into new position?
Re: brainstem compression
Posted: Sat Jan 26, 2013 8:08 pm
by Cece
who knows
I think the veins are pretty set in their positions though.
Haven't watched this yet but it appears to be a 28 minute video of Dr. Arata discussing these ideas: