This Is MS Multiple Sclerosis Knowledge & Support Community

Posted: **Fri Sep 27, 2013 11:09 am**

The http://www.ncbi.nlm.nih.gov/pubmed/22357458 paper cited by cheerleader just now made me sit up and take notice. It was done in Poland, where the furor about CCSVI and MS may not be much different than it is here. It appears to again confirm the association with "MS", using some of the Zamboni criteria, but it also observed something else:

This study also revealed a correlation between the occurrence of inverted flow in patients in a sitting position and chronic progressive MS (P = 0.0033).

Is this caused by fatigue, lack of remissions, and wheelchair use? Is it that people who sleep less than the average are more likely to become chronic progressive? Should those people have avoided that position while awake? Can it be connected with CVI in the legs/feet? It certainly fits my experience, though it feels like I have "inverted flow" more when lying down and/or when my legs get warm in either position.

I think "inverted flow" means reflux.

Posted: **Fri Sep 27, 2013 2:15 pm**

Another paper of interest;
Deep Gray Matter Perfusion in Multiple Sclerosis
Dynamic Susceptibility Contrast Perfusion Magnetic Resonance Imaging at 3 T
Objectives To assess the presence of perfusion abnormalities in the deep gray matter of patients with relapsing-remitting and primary progressive multiple sclerosis (MS) in comparison with healthy controls and to investigate the impact of perfusion impairment on clinical disability and fatigue.

Patients Twenty-two patients with MS and 11 age- and sex-matched healthy volunteers.

Intervention Absolute cerebral blood flow, cerebral blood volume, and mean transit time were measured in the thalamus, putamen, and caudate nuclei.

Main Outcome Measures Decrease of cerebral blood flow in the deep gray matter of patients with MS and correlation between perfusion impairment and the severity of fatigue.

Results The cerebral blood flow value averaged over the thalamus, putamen, and caudate nuclei was significantly lower in patients with primary progressive MS (P<.001) and in patients with relapsing-remitting MS (P = .01) compared with controls, and there was a trend for patients with primary progressive MS to have lower average cerebral blood flow than patients with relapsing-remitting MS (P = .06). With respect to cerebral blood volume, there was a significant difference between patients with primary progressive MS and controls (P<.001) and between the 2 groups of patients (P = .03) but not between patients with relapsing-remitting MS and controls (P>.30). The fatigue score was significantly correlated with cerebral blood flow (r = 0.4; P<.001) and cerebral blood volume (r = 0.5; P = .004).

Conclusion The decrease of tissue perfusion in the deep gray matter of patients with MS is associated with the severity of fatigue.
http://archneur.jamanetwork.com/article ... eid=793392

Posted: **Fri Sep 27, 2013 2:22 pm**

Another page on perfusion decreases;
Abnormalities of cerebral perfusion in multiple sclerosis
W Rashid1, L M Parkes2, G T Ingle1, D T Chard1, A T Toosy1, D R Altmann1,3, M R Symms1,4, P S Tofts1, A J Thompson1, D H Miller1
+ Author Affiliations

1MS NMR Research Unit, Departments of Neuroinflammation and Headache, Brain Injury and Rehabilitation, Institute of Neurology, University College London, UK
2F.C. Donders Centre for Cognitive Neuroimaging, Trigon 181, NL-6500 HB Nijmegen, The Netherlands
3London School of Hygiene and Tropical Medicine, Keppel St, London, UK
4MRI Unit, National Society of Epilepsy, Chalfont St. Peter, Buckinghamshire, UK
Correspondence to:  Professor D H Miller  NMR Research Unit, Department of Neuroinflammation, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK; d.miller@ion.ucl.ac.uk
Received 15 August 2003
Accepted 26 November 2003
Revised 20 October 2003
Abstract
Background: Measuring perfusion provides a potential indication of metabolic activity in brain tissue. Studies in multiple sclerosis (MS) have identified areas of decreased perfusion in grey matter (GM) and white matter (WM), but the pattern in clinical subgroups is unclear.

Objectives: This study investigated perfusion changes in differing MS clinical subgroups on or off β-interferon therapy using a non-invasive MRI technique (continuous arterial spin labelling) to investigate whether different clinical MS subtypes displayed perfusion changes and whether this could give a further insight into the pathological mechanisms involved.

Methods: Sixty patients (21 relapsing remitting, 14 secondary progressive, 12 primary progressive, 13 benign) and 34 healthy controls were compared. Statistical parametric mapping (SPM ’99) was used to investigate regional variations in perfusion in both GM and WM. Global WM perfusion was derived by segmenting WM from images using T1 relaxation times.

Results: Regions of lower perfusion in predominantly GM were observed in the primary and secondary progressive cohorts, particularly in the thalamus. Increased WM perfusion was seen in relapsing remitting and secondary progressive cohorts.

Conclusions: Low GM perfusion could reflect decreased metabolism secondary to neuronal and axonal loss or dysfunction with a predilection for progressive forms of MS. Increased WM perfusion may indicate increased metabolic activity possibly due to increased cellularity and inflammation. Improved methodology and longitudinal studies may enable further investigation of regional and temporal changes, and their relationship with physical and cognitive impairment.
http://jnnp.bmj.com/content/75/9/1288.short

Posted: **Fri Sep 27, 2013 3:14 pm**

Quote
Nigel,
Blood does not enter the grey matter, this paper is discussing perfusion not blood flow.
Kind regards,
MarkW
Reply
No love lost Mark,
here is the article that I copied that quote from, I guess you will be wanting to tell them where they have gone wrong to?
From the FB page; https://www.facebook.com/MSResearchAust ... ts&fref=ts
;)
Nigel
Quote
The basic medical science is:
-blood does not eter the brain
-blood brain barrier stops it
-CSF surronda the brain
-brain includes white and grey matter
Facebook is hardly a medical reference book, Wikipedia (with references) is better but there are many texbooks to verify this.
The published paper does not use the phrase "grey matter blood flow" because it is edited for accuracy.
MarkW
===================================================================
For anyone else confused by Mark's statement that blood does not enter the brain.
Blood travels through the brain within vessels and capillaries which are lined with the BBB/endothelial layer. The blood doesn't physically leave the vessels or capillaries UNLESS there is a breach such as a leakage caused by CCSVI. The lining of the vessels has the endothelial layer which is the 'BBB' and is continuous throughout the insides of the blood vessels and permeable for the single cell sized 'products' that are needed to go back and forward, but in essence or technically, not for blood to directly contact/enter the brain tissue.
So blood does enter the brain but is separated from directly contacting the tissue cells by the lining of blood vessels. White and Grey matter have blood vessels and capillaries throughout them and those capillaries are lined with BBB/ endothelial cells.
Quote;
" Blood–brain barrier
From Wikipedia, the free encyclopedia
Part of a network of capillaries supplying brain cells
The astrocytes type 1 surrounding capillaries in the brain
A cortical microvessel stained for blood–brain barrier protein ZO-1
The blood–brain barrier (BBB) is a separation of circulating blood from the brain extracellular fluid (BECF) in the central nervous system (CNS). It occurs along all capillaries and consists of tight junctions around the capillaries that do not exist in normal circulation.[1] Endothelial cells restrict the diffusion of microscopic objects (e.g., bacteria) and large or hydrophilic molecules into the cerebrospinal fluid (CSF), while allowing the diffusion of small hydrophobic molecules (O2, CO2, hormones).[2] Cells of the barrier actively transport metabolic products such as glucose across the barrier with specific proteins.[citation needed] This barrier also includes a thick basement membrane and astrocytic endfeet."
http://en.wikipedia.org/wiki/Blood%E2%8 ... in_barrier

Hope that clarifies for everyone, and also Mark, the basics of how the blood travels within the brain 'surrounded' by the 'BBB/endothelial layer/internal vessel lining' to separate the blood from direct contact with the tissues and cells. It is not that there is only CSF within the brain and blood outside the brain, there are regions of the brain supported and or using CSF as a separate fluid flow to the blood flow within and surrounding the brain and cord though.

;)
Nigel
The English language is such a challenge some times, even for the English!

Posted: **Mon Oct 14, 2013 12:18 pm**

NZer1 wrote: MarkW is quoted:
Blood does not enter the grey matter, this paper is discussing perfusion not blood flow.
The basic medical science is:
-blood does not enter the brain
-brain includes white and grey matter
-blood brain barrier stops it
-CSF surronds the brain
===================================
Nigel (NZer1) differs with me and says:
Blood travels through the brain within vessels and capillaries which are lined with the BBB/endothelial layer. The blood doesn't physically leave the vessels or capillaries.....
He quotes;
"Blood–brain barrier
From Wikipedia, the free encyclopedia
The blood–brain barrier (BBB) is a separation of circulating blood from the brain extracellular fluid (BECF) in the central nervous system (CNS)."
http://en.wikipedia.org/wiki/Blood%E2%8 ... in_barrier

Nigel has found correct information but has interpreted it incorrectly.

I hope that everyone understands these basics:- blood (especially red blood cells and white blood cells) travel in blood vessels, surrounded by the BBB which separates blood from direct contact with brain tissues and cells (eg white and grey matter). This may sound like semantics but it is very important to appreciate the separation of blood and brain, as breaches of the BBB are understood to be important in MS. For me the answer is in the name of the BBB (blood brain barrier).
Happy learning.

MarkW

Posted: **Mon Oct 14, 2013 12:20 pm**

MarkW wrote:
NZer1 wrote: Quoting me (markw):
Blood does not enter the grey matter, this paper is discussing perfusion not blood flow.
The basic medical science is:
-blood does not enter the brain
-brain includes white and grey matter
-blood brain barrier stops it
-CSF surrounds the brain
===================================
Nigel (NZer1) differs with me and says:
Blood travels through the brain within vessels and capillaries which are lined with the BBB/endothelial layer. The blood doesn't physically leave the vessels or capillaries.....
He quotes;
"Blood–brain barrier
From Wikipedia, the free encyclopedia
The blood–brain barrier (BBB) is a separation of circulating blood from the brain extracellular fluid (BECF) in the central nervous system (CNS)."
http://en.wikipedia.org/wiki/Blood%E2%8 ... in_barrier
Nigel has found correct information but has interpreted it incorrectly.
I hope that everyone understands these basics:- blood (especially red blood cells and white blood cells) travel in blood vessels, surrounded by the BBB which separates blood from direct contact with brain tissues and cells (eg white and grey matter). This may sound like semantics but it is very important to appreciate the separation of blood and brain, as breaches of the BBB are understood to be important in MS. For me the answer is in the name of the BBB (blood brain barrier).
Happy learning.
MarkW

Posted: **Mon Oct 14, 2013 1:04 pm**

MarkW wrote:
NZer1 wrote: MarkW is quoted:
Blood does not enter the grey matter, this paper is discussing perfusion not blood flow.
The basic medical science is:
-blood does not enter the brain
-brain includes white and grey matter
-blood brain barrier stops it
-CSF surronds the brain
===================================
Nigel (NZer1) differs with me and says:
Blood travels through the brain within vessels and capillaries which are lined with the BBB/endothelial layer. The blood doesn't physically leave the vessels or capillaries.....
He quotes;
"Blood–brain barrier
From Wikipedia, the free encyclopedia
The blood–brain barrier (BBB) is a separation of circulating blood from the brain extracellular fluid (BECF) in the central nervous system (CNS)."
http://en.wikipedia.org/wiki/Blood%E2%8 ... in_barrier
Nigel has found correct information but has interpreted it incorrectly.
I hope that everyone understands these basics:- blood (especially red blood cells and white blood cells) travel in blood vessels, surrounded by the BBB which separates blood from direct contact with brain tissues and cells (eg white and grey matter). This may sound like semantics but it is very important to appreciate the separation of blood and brain, as breaches of the BBB are understood to be important in MS. For me the answer is in the name of the BBB (blood brain barrier).
Happy learning.
MarkW

Thanks Mark,
you might like to add about Dura matter and how that fits into your understanding so we can appreciate the way the BBB encloses the Brain and Spinal Cord and what are the contents of the dura layer in relation to the BBB.

This Is MS Multiple Sclerosis Knowledge & Support Community

Reduced grey matter blood flow detected and measured!

OT but the reference I used is in this thread

Re: Reduced grey matter blood flow detected and measured!

Re: Reduced grey matter blood flow detected and measured!

Re: Reduced grey matter blood flow detected and measured!

Grey/white matter contains no blood cells

Re: Grey/white matter contains no blood cells

Re: Grey/white matter contains no blood cells