CCSVI and CCVBP

[uprightdoc]

Hello Francis

I will look for the PM tomorrow with information about Chiari and your question.

I don't know what they are referring to when you say "liquor." The term "liqour" could be referring to CSF, inflammation or edema. What is the level of the spinal cord where the doctor sees the weird stains?

[mystery1980]

Hello Dr. Flanagan,

Then I asked it wrong my apologize.
I mean the weird stains in my opinion not the doctor.

And I mean right next to the spinal cord, on the image they are in my opinion vague spots?

Kind regards,

Francis

[uprightdoc]

Hello Francis,

I don't know if you are referring to dark spots or bright spots. The brain and spinal cord are dark in this image. Areas with high water content are white in this image. The gray looking spinal cord should be surrounded by white areas with water. The white area is CSF. CSF is mostly water. Inflammation and edema also produce water. Inflammation is hot water. Edema is cold water. Inflammation tends to dry tissues out so it is not as bright as edema. I cannot see enough detail of the bright white spots. The long white streak is the syrinx. There also appears to be some small circumscribed white spots that could be inflammation or edema. The thoracic cord is difficult to see because of the syrinx and edema.

[uprightdoc]

Hello Francis,

I will answer the PM questions you have for the neurosurgeon here because it is not too personal and it will help to educate others who follow this thread: 1) you have low lying cerebellar tonsils that indicate a Chiari 0 in the recumbent (supine) position. 2) You have many symptoms of cerebellar tonsillar ectopia 3) you have a long syrinx that was likely present before the scooter and car accident probably due to underdeveloped (hypoplasia) of the fourth ventricle foramen 4) Chiari malformations are associated with syrinxes 5) You had fatigue and other symptoms before the scooter and car accidents 6) You were knocked unconscious after the scooter accident and you don’t know how you landed 7) you have a possible thoracic disc or bone fragment in your thoracic spine that is most likely due to the scooter accident your current symptoms mostly started after the scooter and car accident 9) the scooter accident may have damaged muscles and ligaments in the craniocervical junction resulting in a chronic strain (misalignment) 10) the structural strain of the craniocervical junction is causing tension on the dura mater and pulling the cerebellar tonsils toward the foramen magnum as well as deforming the subarachnoid space 11) the cerebellar tonsillar ectopia and deformation of the subarachnoid space is obstructing blood and CSF flow between the cranial vault and spinal can thus redirecting CSF into the central canal and syrinx causing it to expand. 12) the upright (vertical)position most likely makes the Chiari worse 13) you lost consciouness when you got up from lying down and fell down a flight of stairs 14) an upright (vertical) MRI will show whether or not the cerebellar tonsillar ectopia drops lower when you are in the upright (vertical) position.

I don't know why there is a smiley in place of the number 8. I didn't put it there.

You have my permission to cut and paste my comments and send them to the neurosurgeon.

[Robnl]

8 ) is a smiley doc ( without the space)

[uprightdoc]

Thanks Robert. I get it. It's a face on it's side. I am definitely not up to speed on emoticons. .

[uprightdoc]

Eureka. It really works!

[uprightdoc]

Hello Francis,

You should also discuss with the neurosurgeon having an expert radiologist check for injuries and tears of the upper cervical muscles and ligaments. Most radiologists don't look or overlook trauma and tears in the upper cervical tissues. Upright (vertical) cervical MRI with flexion and extension views would be helpful. Basic x-rays of your cervical spine including AP, Lateral and open mouth odontoid views would also be helpful.

[mystery1980]

Thank you very much Dr. Flanagan for all of the information!

I wil make / send the e-mail after the holidays.

Were there only more if you, if you now what I mean ;)

And with the image were we talking about before I meant the bright spots ( this image is the one before you see the spinal cord good on the mRI )

When I have more questions, can I continue to ask?

Kind regards,

Francis

[uprightdoc]

You are very welcome Francis.

If you have additional questions feel free to ask them.

[Robnl]

Just saw some beautiful pics of merril magee; what a nice place!

[uprightdoc]

Thanks Robert. We are slowly putting the property and buildings back together. They were a wreck when we bought them. We are working on the new restaurant now and hope to open in the spring. I am installing a "grundofen" in the new dining room for comfort and ambiance, as well as to save energy because the room is a conservatory with many windows. Most Americans aren't that familiar with Finnish, German and Russian style furnaces. They are just starting to catch on here. The old Merrill Magee house has several Rumford Fireplaces which were an improvement on American designs at the time. American fireplaces suck more heat out of the house then they put into it. Rumford was a competitor with Benjamin Franklin who invented the Franklin Wood Stove. They were both designed in the early 1800s. Neither the Rumford fireplace or Franklin wood stove can compare with the European designs that date back 400-500 years ago and are as efficient as today's modern high efficiency furnaces but they have no moving parts, just perfect draft and combustion and they always work even when the power goes out.

[Robnl]

Abstract

In this review, the impact of restricted cerebral venous outflow on the biomechanics of the intracranial fluid system is investigated. The cerebral venous drainage system is often viewed simply as a series of collecting vessels channeling blood back to the heart. However there is growing evidence that it plays an important role in regulating the intracranial fluid system. In particular, there appears to be a link between increased cerebrospinal fluid (CSF) pulsatility in the Aqueduct of Sylvius and constricted venous outflow. Constricted venous outflow also appears to inhibit absorption of CSF into the superior sagittal sinus. The compliance of the cortical bridging veins appears to be critical to the behaviour of the intracranial fluid system, with abnormalities at this location implicated in normal pressure hydrocephalus. The compliance associated with these vessels appears to be functional in nature and dependent on the free egress of blood out of the cranium via the extracranial venous drainage pathways. Because constricted venous outflow appears to be linked with increased aqueductal CSF pulsatility, it suggests that inhibited venous blood outflow may be altering the compliance of the cortical bridging veins.

http://www.pagepressjournals.org/index. ... .2014.1867

[uprightdoc]

Thanks Robert. It's an excellent paper.

While the paper discusses the role of the bridging veins in adults with NPH it doesn't discuss hydrocephalus in children. Hydrocephalus in children is typically attributed to stenosis of the cerebral aqueduct between the third and fourth ventricle. Some authors now maintain that the stenosis is due to decreased venous flow that causes a decrease in CSF and interstitial fluid flow resulting in compression of the cerebral aqueduct by surrounding fluid pressures. In this regard, the cerebral aqueduct passes through the midbrain which is surrounded by the interpeducular and superior cerebellar cisterns. I proposed my theory of the cisterns compressing and damaging nearby structures close to thirty years ago. The paper also falls short in its coverage of the vertebral veins. While it mentions CCSVI, it doesn't mention much about CCSVP caused by malformations and misalignments of the craniocervical junction. Malformations and misalignments of the craniocervical junction and spondylosis, stenosis and scoliosis cause compression of the epidural veins of the spinal canal and cord. The epidural veins are the homologue of the bridging veins in the cranium. Compression of the epidural veins of the spinal canal can likewise affect venous and CSF pressure gradients and flow in the cranial vault and brain.

I connect all the dots and cover craniospinal hydrodynamics from head to foot in children and adults in my next book. Everyone else in thirty years behind.

[Robnl]

Yes, still pieces of the puzzle; Zamboni ccsvi, flanagan ccVbp

Should be united....for me; ballooning helped mentally, physically for 6 weeks...i think it was the period that csf etc had benefit from the better blood flow. But then it got stuck again....csf problems were not fixed...

Had a Nice xmas doc? In Holland we have TWO xmas days....so today we go to my parents