The Cisterns and Cine CSF Flow Studies

The unusual images on the left and below were taken of the  head and neck area looking at the patient from the side.  The face is on the left side of the image. The images are called cine MRI because they are similar to cinema photography. In cinema photography many still pictures are taken and played back at high speed, which make the images appear to be moving.

In this image the speckled black and white areas are air surrounding the patient, as well as air in the paranasal (air) sinuses, the nose, the mouth and the throat. The more uniform gray area is the patient’s skin, fat, bones and muscles. If you click on the image you will see the movement of cerebrospinal fluid (CSF). The streaks of black that quickly appear and disappear in the moving image is cerebrospinal fluid (CSF), which is mostly water with sugar and some other elements mixed in. Although this particular image shows CSF flow, cine MRI can also be used to show blood flow.

These cine MRI images are from the FONAR Corporation. FONAR Corporation was founded by Dr. Raymond Damadian who was instrumental in the development of today’s modern MRI scanners. More recently, Dr. Damadian invented the upright MRI, which is going to change the way we see injuries, degenerative changes and diseases of the spine, brain and cord. The images are from a study by Dr. Damadian of eight patients with multiple sclerosis called, The Possible Role of Cranio-Cervical Trauma and Abnormal CSF Hydrodynamics in the Genesis of Multiple Sclerosis, published in the journal of Physiological Chemistry and Physics and Medical NMR in 2011. All of the eight cases were associated with trauma and all of them showed obstruction of CSF flow. The image below on the right is one of the cases.

The problem with conventional MRIs is that they are taken with the patient lying down. The problem is that upright posture causes significant changes in the mechanical loads acting on the spine, as well as fluid flow in the brain and cord. In contrast to humans, in most mammals the primary forces acting on the spine, while standing on four legs, are tension and shear stresses. In humans, upright posture primarily causes compression loads on the segments of the spine. Compression causes the segments of the spine to cave, bulge and slip in different directions when there is instability. Many conditions of the spine, brain and cord appear normal or acceptable when an MRI is taken with the patient lying down because the abnormalities only show when the patient is upright. Dynamic or kinematic upright MRI takes images in different positions, such as foward or backward bending of the spine. Dynamic MRI images picks up even more problems that might otherwise be missed by upright MRI alone.

As mentioned above, cine MRI images use fast moving still pictures that are taken in pixels and digitized for computerized imaging. The cameras are gated. Gated simply means that the MRI cameras are timed to take the images at particular intervals. In this case they are gated (timed) to take images based on the beat of the heart.  In these images, CSF (on it’s way out of the brain) appears as flashing streaks of black on the front and back side of the brain and cord. It then quickly disappears. The black streaks show up when a large volume of blood is pushed into the cranial vault and brain by the contraction of the heart. As it does, an equal amount of venous blood and CSF is driven out of the cranial vault and into the spinal canal and cord. If you study the images closely you will notice that the image at the top of the page shows a clear continuous and uninterrupted normal pattern of CSF flow between the brain and cord, as well as a champagne glass shape to the passages. Click on the image below and compare the differences.

In the moving image you see black streaks the same as in the normal cine CSF flow study above, but the streaks are interrupted in certain areas or not as dark. If you look at the area the black arrow is pointing to you will see that the dark streak suddenly stops compared to the normal cine CSF MRI image above. If you look for the shape of the champagne glass you will see it is barely noticeable or missing on the back side. Instead, there is a dark streak with intense white streaks within located at the top of the champagne glass in the back of the brain. Those mixed black and white streaks are out of synchrony with the normal flow of CSF and they are probably going in the wrong direction. In other words, they are turbulant inversion flows or backjets of CSF in the brain. They could also be standing waves, or as kayakers prefer to call them, clapotis.

The dural sinuses (veins) that drain blood from the brain during upright posture follow a similar course to the CSF seen as black streaks in these images and empty into the vertebral veins inside the spinal canal. When the heart contracts, venous blood is driven out of the cranial vault along with CSF and both must exit together through the foramen magnum in the base of the skull and into the spinal canal. The vertebral veins are located between the walls of the spinal canal and the outer covering of the cord called the dura mater. The space is thus called the epidural space. CSF passes through the subarachnoid space inside the cord. Therefore, if venous blood flow becomes obstructed in the epidural space at or below the foramen magnum in the cervical spinal canal, the hydraulic pressure that follows is transmitted to the subarachnoid space of the cord and can affect CSF flow.

It has been my theory for the past 30 years that the blockage of CSF flow is most likely one of the root causes of neurodegenerative diseases of the brain such as Alzheimer’s, Parkinson’s, and multiple sclerosis. A decrease in CSF flow can affect the brain in several ways. One of the ways I suspect it causes damage to the brain is from backjets (and turbulance) of CSF in the cisterns of the brain. The cisterns are on the front and back side of the brain stem and cerebellum. The outline of the cisterns in these images is the champagne glass shape. Over time, chronic CSF backjets, turbulance and standing waves can compress and damage the brain.

There are many conditions of the spine that can affect blood and CSF flow in the brain and cord. For further information on increased CSF volume and backjets in the cisterns check out my website page on atrophy dysautonomia. Or visit the website at www.upright-health.com.

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Posted in Alzheimer's, amyotrophic lateral sclerosis, arachnoid cysts, chiari malformations, empty sella syndrome, multiple sclerosis, Parkinson's, spondylosis | 6 Comments

CSF Cistern Compression of the Brainstem

Images from a patient with normal pressure hyd...

Image via Wikipedia

CSF and blood are pumped into the brain under pressure similar to a bicycle pump filling a tire tube.  The pressure of the pump comes from the heart and lungs.  Since the brain is housed inside a closed container, which is filled to capacity, the increase in blood volume must be offset by a decrease in venous blood and cerebrospinal fluid (CSF). This is accomplished by pushing a proportionate amount of blood and CSF out through the large opening in the base of the skull called the foramen magnum and into the spinal canal.

Typically, when a radiologist views x-rays or MRI’s of the spine they don’t consider misalignments of the upper cervical spine or degeneration and changes in the normal curves of the lower spine to be a problem unless it causes contact with the spinal cord. This disregards the impact on the vertebral veins that are located between the spinal canal and cord. As the heart contracts blood and CSF are pushed into the spinal canal at the same time and thus compete for available space.

Humans use the occipital marginal sinus and emissary veins to drain the brain during upright posture. These veins empty into the vertebral veins of the spine. Misalignments of the upper cervical spine can affect blood and CSF flow as it passes between the cranial vault and spinal canal. Likewise, spondylosis (degenerative changes), stenosis (narrowing of the spinal canal) and scoliosis (abnormal curves) in the lower spine can also affect blood and CSF flow between the cranial vault and spinal canal.

The picture on the left is used with permission from Johan Linder of Clapotis Sea Kayak in Sweden. The pumping of the heart causes CSF waves to form in the brain and spinal cord. Respiration further increases the size of the waves. More than the heartbeat or respiration, upright posture significantly increases the pressure of the waves that form at the bottom of the cranial vault. (To see the affects of upright posture venous pressure inside the skull see my previous posts with pictures of the sutures).

When waves collide they cause standing waves called clapotis. If waves of blood and CSF from the brain collide with waves in the cervical spine they will cause inversion (reverse) flows and standing waves to form in the cisterns that surround the brainstem and cerebellum. Chronic standing waves may lead to compression and subsequent malfunction and degeneration of the structures they surround. Increased CSF volume, backjets (inversion flows) and standing waves in the CSF may play a role in neurodegenerative diseases.

Multisystem atrophy (MSA) is a variant of Parkinson’s disease associated with dysautonomia and cerebellar signs. Dysautonomia is dysfunction (malfunction) of the autonomic (vegetative) nervous system which regulates all the vital and internal functions of the body. The cerebellum is important to posture, coordination, balance and gait (walking). Many neurodegnerative diseases are similarly associated with dysautonomia and cerebellar signs.

There is a variant of MSA formerly referred to as olivopontocerebellar atrophy. It is associated with dysautonomia. It is also associated with atrophy, which means a decrease in the size of the brainstem and cerebellum. I suspect the atrophy is due to obstruction of CSF flow between the brain and cord that eventually erodes the brainstem and cerebellum similar to the impact of relentless pounding of waves of the Atlantic against the northeast coastline of North America.

The relentless pounding of waves can tear apart rocks. They can similarly compress and erode the brain. For further information on CSF, cisterns, atrophy of the brainstem, dysautonomia, cerebellar signs and Parkinsonism visit my website at www.upright-health.com or click on the link above.

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Cervical Spondylosis and CSF Flow in the Cisterns

The brain is surrounded by a watery substance called cerebrospinal fluid (CSF), which is produced in chambers called ventricles located in the middle of the brain. In the MRI image on the right, the brain is white and CSF is black. The CSF pathways for the most part are smooth and there are no obstructions.

CSF  volume and pressure in the brain change with the contraction and relaxation cycles of the heart. When the heart contracts, a large volume of blood in the arteries is driven into the brain. To compensate for the increase in arterial blood volume a proportionate amount of venous blood and CSF is squeezed out of the cranial vault and into the spinal canal.

The outflow of blood and CSF is affected by the design, dimensions and alignment of the foramen magnum in the bottom of the skull and the spinal canal of the upper cervical spine. Many inherited (genetic) and acquired conditions of the base of the skull and upper cervical spine can decrease blood and CSF flow through the foramen magnum and upper cervical spine. Inherited conditions include: Arnold-Chiari malformations, Dandy-Walker syndrome, craniosynostosis, Klippel-Feil (fused cervical segments) occipitalization (fused upper cervical spine and skull), as well as others.  Aquired conditions include aging and injuries. Aging causes muscles, bones and connective tissues to degenerate, which can affect the tunnels nerves and blood vessels pass through. Injuries cause similar problems and hasten degeneration associated with aging.

Cervical spondylosis is a general term used to describe degenerative conditions of the cervical portion of the spine. Spondylosis can also occur in the thoracic and lumbar spine as well. All forms of spondylosis affect the design, dimensions and alignment of the spinal canal. The spinal canal is a tunnel that contains the spinal cord. It also contains arterial blood vessels that supply the spinal cord with fresh oxygenated blood and the verebral venous plexus, which is a dense network of veins, that drains the spinal cord and brain. The remainder of the space is filled with loose fat.

After passing through the foramen magnum and spinal canal of the upper cervical spine, venous blood and CSF that has been squeezed out of the brain during contraction of the heart and exhalation must flow through the lower cervical spinal canal. In the picture above on the left the brain is black and CSF is white. If you look closely at the cervical spine you will notice that the spinal canal is constricted due to spondylosis. In medical terms it is called stenosis, which means narrow. The cause of the stenosis in this case is spondylosis (degeneration of the spine).

In a previous post called CSF, Cisterns, Clapotis and Cysts, I discussed seawalls and standing waves called clapotis. The picture on the right is of Thunder Hole in Acadia National Park off the coast of Maine in North America. Over time the ocean eroded the shoreline and formed a tight canal. The water speeds up as it passes through the tight canal and crashes into the wall at the end causing it to sound like thunder and shoot straight up into the air.

Alterations in the design and dimensions of the lower cervical spine such as from cartilage and connective tissue degeneration can affect blood and CSF flow in the spinal canal similar to land masses that jut out into rivers. Land masses and seawalls reflect incoming waves that then travel back out to sea. When they meet up with another incoming wave the two combine and form a standing wave that is twice the size of the individual waves.

If the design and dimensions of the cervical spinal canal are correct, the blood and CSF will flow smoothly with little resistance. If the path is obstructed by cervical spondylosis (degeneration) their flow will become turbulent. If it becomes sufficiently restricted and turbulent it will cause back pressure and standing waves to form in the brain. Overtime, standing waves can tear apart shorelines. They can similarly damage the brain.

The first areas to receive the brunt of the standing waves are the basal cisterns of the brain. The cisterns are dilated pouches in the subarachnoid space in the outer coverings of the brain. The cisterns are filled with CSF and protect the brain from contact with bones of the base of the skull. The subcompartment in the base of the skull, called the sella turcica for the pituitary gland is also affected. An increase in CSF volume and pressure in the cisterns and sella turcica can cause problems in the brainstem and pituitary gland. It may also explain why some patients with neurodegenerative diseases have problems with the autonomic nervous system referred to as dysautonomia.

Standing waves may play a role in Dandy-Walker syndromes, Arnold-Chiari malformations, arachnoid cysts, empty sella syndromes, multiple sclerosis, Parkinson’s disease, Shy-Drager syndrome, Alzheimer’s disease and other neurodegenerative conditions.

For more information on spondylosis visit my website http://www.upright-health.com/cervical-spondylosis.html .

Posted in Alzheimer's, arachnoid cysts, chiari malformations, CSF, Dandy-Walker syndrome, empty sella syndrome, multiple sclerosis, Parkinson's, spondylosis | Tagged , , , | 17 Comments

CSF Fountains, Pulsations and Flow

The famous neurosurgeon Dr. Harvey Cushing stated that cerebrospinal fluid (CSF) flow is the third circulation of the brain. More recently in chapter six of Clinical Neurology published by Lippencott in 2006, Dr. Joseph Madson and others elaborated on Dr. Cushings description of CSF flow. They stated that CSF pulsations are the fourth circulation of the brain.

The open sutures, as seen in the picture, on an infants skull are called fontanelles , which means little fountains. They are known as “soft spots” in layman’s terms. The soft spots were so named because you can feel the pulsations of the brain at the fontanelles.

The fontanelles separate the plates of bone that cover the brain called membranous bones. They are called membranous bones because they grow within the outside covering of the brain and develop along with the brain. The membrane of the brain is made of dura mater, which means hard mother in Latin, so the soft spots aren’t as soft as they appear. They are actually relatively tough and difficult to penetrate. If you look closely at the infant skull above you will notice that the edges of the sutures are relatively smooth compared to the adult skull below. The sutures develop their characteristic shape as an infant matures. In either case, like all bones, their shapes are caused by the stresses that strained them.

If a baby becomes dehydrated the soft spots will sink. On the other hand, if the volume of cerebrospinal fluid in the brain increases, such as in hydrocephalus, the soft spots will feel tense and bulge outward. Typically, the fontanelles eventually disappear and the membranous bones are joined by their opposing surface that form into the shapes of surgical sutures. Hense the joints of the skull are called sutures.

Hydrocephalus in children is caused by blockage of CSF flow. The blockage of CSF flow causes the volume of CSF in the brain to increase. The increase in CSF volume causes the sutures to stay open and the head to increase in size. On the other hand, in some cases, there is premature closing of the sutures called craniosynostosis. Most cases of craniosynostosis cause mild almost imperceptible malformations of the skull and have no impact on health. In certain cases, however, premature closure of the sutures can cause hydrocephalus due to resistance to growth and development of the brain and subsequently CSF volume.

In any case, the shape of the soft spots and sutures of the skull are a reflection of cranial hydrodynamics, which is fluid mechanics in the brain and skull. The fluid mechanics are the result of electrical, circulatory and respiratory waves. Those waves are further amplified and modified by upright posture.

Strong CSF pulsations are a sign of good circulation and health. Weak pulsations are a sign of ill health and old age. On the other hand, when they get out of hand, waves can move boulders in rivers and tear apart the most imposing shorelines and obstacles. They can also cause malformations of the skull, as well as cause the sutures to stay open, as mentioned above. The pulsations of the brain also cause the irregular wave-like shapes of the sutures. They even leave little impressions on the inside roof of the skull where special valves, called arachnoid granulations, squirt CSF into the venous drainage system of the skull called dural sinuses.

If the pulsations can shape, indent and move the bones of the skull they can easily compress, dent and deform the brain and, in fact, they do. When the heart contracts a considerable amount of blood is driven into the brain, which compresses the brain, veins and CSF pathways. This drives venous blood and CSF out of the cranial vault and brain. When the heart relaxes, the brain, veins and CSF pathways expand which draws blood into the tissues of the brain, and pulls waste out of tissue spaces and into the drainage system ready to be removed on the next cycle. The heart thus causes the brain to rhythmically expand and contract.

Problems occur when waves get out of control. I liken them to rogue waves and describe them in more detail on my prior post. When CSF volume gets out of control it can damage the brain. Likewise, when CSF waves get out of control they can damage the brain as well. The basal cisterns (wells) that surround the brainstem and cerebellum with CSF, are the first place to experience the brunt of rogue waves and the most likely to suffer the consequences. I suspect that chronic pounding from rogue waves can cause damage.

Rogue waves may play a role in arachnoid cysts, cystic ventricles  as in Dandy-Walker syndrome and the variant of Parkinson’s called multisystem atropy or Shy-Drager. It most likely plays a role in empty sella syndrome and hormonal problems, as well as other conditions. I further suspect that one of the likely sources for destructive rogue waves in the brain comes from the cervical spine.

The first and most likely source of rogue waves is from malformations and misalignments in the upper cervical spine. Another is backjets due to whiplash, a phrase coined by              Dr. Frans  Schelling. Still another cause of the destructive, reflected waves is spondylosis lower down in the cervical spine.

Spondylosis is the term for degeneration of the spine. Among other things, spondylosis compresses the spinal canal and vertebral veins, which affects blood and CSF flow, as well as causing standing waves in the basal cisterns of the brain. Blockage of the vertebral veins affects blood and CSF flow in the brain. Overtime, chronic pounding from standing waves (clapotis-see prior posts) in the basal cisterns can compress the parts they surround and damage the brain. I will discuss spondylosis, seawalls and standing waves in next post.

For further information on related topics go to my website at www.upright-health.com.

Posted in Alzheimer's, ccsvi, CSF, multiple sclerosis, Parkinson's, spondylosis | 3 Comments

CSF Currents, Winds and Tides

In 1925 the famous neurosurgeon Dr. Harvey Cushing published one of his lectures in Lancet in which he described cerebrospinal fluid (CSF) as the third circulatory system of the brain. The dynamic flow of the third circulatory system of the brain and cord can be compared to a current that comes out of large lakes and rivers fed by rainfall and streams and connected by a gulf to a much larger ocean. Winds whip up the water and the currents and tides collide in the gulf, which results in waves.

The sketch above on the right shows the Great Lakes of North America where rain water gathers from surrounding hills and streams. The water is carried by currents that flow out of the lakes by way of the Saint Lawrence River where it enters the Saint Lawrence Gulf, which is continuous with the ocean. Compared to the vast Atlantic Ocean, all the Great Lakes combined are much smaller in size and capacity.

While the current flows out of the Great Lakes to the ocean the tide of the ocean it runs into varies with the moon and time of day. Sometimes it moves out to sea in the same direction as the flow of the Saint Lawrence. Othertimes the tide comes in and flows against the river’s current. This creates conflict and turbulance where the two meet in the gulf. Over time the water turbulance caused by the ebb and flow of the tide erodes the coasts of Northern America and helps shape its shorelines.

Cerebrospinal fluid (CSF), a filtrate of blood, is basically water with some sugar and other elements mixed in. CSF is produced in the four ventricles (chambers) of the brain. From there it follows through various channels and into every nook and cranny of the brain. It also flows down through the spinal cord. For the most part, as far as we currently know, most CSF finds its way from the cord back to the brain where it eventually flows into the major veins of the brain and exits the skull by way of the internal jugular and vertebral veins.

Click on the sketch of the brain below to enlarge it. (This is a sagittal view meaning looking at one half of the brain and cord as though they were split from front to back.) In this analogy the person is lying on their side. Now look at the sketch as though it was a nautical map of many lakes and rivers with the brain and cord being the land masses. All the folds, creases, crevices and cracks you see in the brain are like large and small fiords filled with water (CSF). The coast of the brain is completely surrounded by the sea so that no surface is untouched by water (CSF). The cord is, likewise, surrounded by water. Both are further bound by large rivers, which are the dural sinuses (veins) of the brain and vertebral veins of the cord.

CSF begins its journey in the lateral ventricles (lakes) located in the center of the brain. The squiggly lines surrounding the lakes are like mountains from which water flows down through streams to fill the lakes. The arrows show the direction of the current and CSF flow in the brain and cord.

The first two lakes flow into the next lake (third ventricle) where additional water from surrounding hills enter the system. It then flows through a tight canal called an aqueduct and enters yet another lake (fourth ventricle) with a large land mass protruding into it. Again, rivers from the surrounding hills that line the coast contribute even more water but this is the last place where water enters the system.

From the last lake (the fourth ventricle) CSF flows out into a gulf called the basal cisterns of the brain. From here, in the gulf, it can flow in one of two directions. It can either flow back up to the top of the brain or it can flow down into the cord. At the bottom of the cord is a large sea called the lumbar cistern. The capacity and volume of CSF (water) in the cord and lumbar cistern, like the ocean, is far greater than the combined capacity of all the ventricles, cisterns and spaces in the brain.

The direction CSF takes when it enters the gulf of the basal cisterns depends on which way the tide is going which is determined by the gravitational pull of the earth, as well as the time of day, which will be explained below. If it gets strong enough, wind can also affect the current and flow of CSF (water) in the cisterns (gulf). It can even cause it to take alternative routes. In either case, once it leaves the (ventricles) lakes where it is produced, CSF moves through channels that don’t contribute any additional water. Those channels are depicted by spaces with stipled lines.

In the position described above (the person on their side) the tide is in and the flow of CSF in the brain and the cord is mostly upwards toward the top of the brain. When it reaches the top of the brain it empties into part of the drainage system of the brain called the venous lacunae, lacunae means lakes. The venous lacunae contain canals called arachnoid granulations that are small protrusions (villi) of the arachnoid layer (middle covering of the brain) that connect the CSF pathways to the largest vein of the brain called the superior sagittal sinus. They transfer CSF back into the blood stream through the venous drainage system.

After it leaves the stipled CSF pathways and enters the superior sagittal sinus by way of the arachnoid granulation, slightly further down you can see a white circle called a confluence. A confluence is a place where rivers meet. In this case several large veins (rivers) meet at the confluence. From here the large veins drain down into the basement of the skull called the posterior fossa and enter into either the internal jugular veins or vertebral veins.

The tide changes in this analogy when we turn the system upright. When we stand upright, the current speeds up and the tide flows away from the brain. During the night when we sleep the tide returns back toward the brain. Hanging upside down (inversion) causes a strong reversal in the tide. Straining while holding the breath, which is called a Valsalva maneuver also causes back pressure against the current and can, likewise, reverse tides. Strong tides can cause rivers to change their course in the brain and seek other outlets. In my book, The Downside of Upright Posture, I discuss giraffes, bats and whales and the forces they have to deal with. Giraffes and bats had to find ways to contend with tides caused by exceptional inversion flows from long necks and spending long periods of time hanging upside down. In giraffes it occurs when they lower their head to drink water. In bats the tides shift when they sleep. In humans tides shift when we wake up from lying down to sit or stand upright.

The first place to feel the affects of shifts in currents and tides in the brain is where they collide in the gulf of the basal cisterns. If you look closely at the picture you will see a cistern above and below the cerebellum. There are also cisterns below and in front of the cord. The cisterns in the spaces above the pons of the cord and the cerebellum surround the midbrain. Among other things the midbrain contains the cerebral aqueduct (canal for CSF flow) and the substantia nigra. The substantia nigra is where dopamine is produced and is affected in Parkinson’s disease. I suspect that increased volume and pressure in the ventricles and cisterns may play a role in Parkinson’s disease. Increased CSF volume and pressure in the ventricles and cisterns may play a role in other neurodegenerative diseases as well.

The wind in the system comes from respiration (breathing). Most times breathing merely creates ripples that help to move CSF along. Sometimes, however, it causes a great deal of back pressure, such as in a Valsalva maneuver mentioned above, which forces CSF to find alternative outlets to exit the brain in order to keep things flowing and prevent backups in the system.

When it comes to the impact of currents, winds and tides, tide has a far greater influence on CSF flow. When large ocean tides rush into small river channels tidal bores (waves) occur. Where river currents and ocean tides collide standing waves called clapotis can occur. Tidal bores and clapotis (covered in my last blog) cause turbulance that moves depris which scour and undermine anything in its wake. Coasts are shaped by the relentless ebb and flow of daily tides. Anything that stands in its way or disrupts the ebb and flow of relentless tide and current is subject to erosion. The same thing happens in the brain.

When it comes to the brain the posterior fossa is the first area to feel the affect of tidal bores and clapotis. If the tidal waves are strong enough it can start to back up into the lakes (ventricles) and affect the structures that line their shores. The first ventricle (lake) to feel the affect is the fourth ventricle (lowest). Not surprisingly, the cisterns and ventricles are similarly affected in Dandy-Walker syndrome seen in children and a variant of Parkinson’s disease called multisystem atrophy or olivopontine cerebellar atrophy seen in adults. Both conditions are associated with enlarged cisterns and cystic (enlarged) fourth ventricles mentioned in previous posts.

Dandy-Walker sydrome is a congenital malformation of the brain originally referred to as Dandy-Walker cysts. It was named after Dr. Walter Edward Dandy and Dr. Earl Walker. The contributions of Dr. Dandy to neurosurgery and our understanding of CSF flow and hydrocephalus are legendary and far too numerous to describe here. Among other things he trained under Dr. Harvey Cushing mentioned above. The Dandy Walker cyst-like malformation is somewhat like a reverse Chiari malformation in that the posterior fossa is too large, the brainstem and cerebellum are too small and the cerebellum herniates upward into the tentorium cerebelli rather than downwards into the foramen magnum. Brain shrinkage and increased CSF volume has also been associated with Alzheimer’s disease and multiple sclerosis.

The choke point in the CSF and venous circulatory system of the brain is in the foramen magnum and upper cervical spinal canal. Degeneration (spondylosis) and misaligments of the lower cervical spine can further affect the current and flow of blood and CSF between the brain and cord. For additional information regarding the connection between the brain and cord visit our site at www.upright-health.com.

Posted in Alzheimer's, arachnoid cysts, chiari malformations, CSF, Dandy-Walker syndrome, empty sella syndrome, multiple sclerosis, Parkinson's | Leave a comment

CSF, Clapotis, Cisterns and Cysts

The picture on the right is an example of clapotis. It comes from a book called Sea Kayak by Gordon Brown who teaches classes in Scotland where sea and surf are notoriously rough. White water and open sea kayakers are attracted to waves and love to study all their subtleties.

Clapotis is a nautical term for standing waves. It is French for lapping of water. According to English translators it is pronounced as clap-o-tee, like a long sounding “o”, as in toe. According to my Canadian French connection, it is pronouned more like clap-ah-tee, similar to the short sound of “o” as in copper. In either case, in French, the “s”, at the end of the word indicates that it is plural, meaning more than one wave, but it is silent.

Clapotis occur when waves clap together such as incoming ocean waves running into waves that have bounced off of objects such as rocky coasts or manmade seawalls. Clapotis can be explosive and sometimes roar from the rush of the water. Like the sound of the “s” on the end, sometimes they can be silent and gentle swells like those that occur between the land masses of a mainland and its barrier islands. The ocean waves are calmer but still reflect between these land masses.

As all sea faring people well know, however, silent or not, standing waves can be deceptive, destructive and even deadly. On the bottom side they scour and tear at the footers of manmade seawalls. They similarly severely undermine and damage coasts. On the top side they can toss and turn ships about like toys in a tub.

Rogue waves are a type of standing wave. They are also known as freak or killer waves because they suddenly spring up seemingly out of nowhere and significantly increase the height and strength of a wave. They often travel against prevailing winds and currents and are sometimes preceded by deep troughs that look like a hole in the ocean. Killer waves can run aground, wreck, roll and swallow unsuspecting ships, sometimes in a matter of minutes and sometimes only seconds. For centuries scientists scoffed at sailors and claimed the sailors were spinning tall tales from too much time spent isolated at sea. New evidence, however, has rocked their boat. Sailors were right, these waves do exist. As yet, we know very little about them or what stirs them up. What we do know is that fluids basically follow pressure gradients and the path of least resistance.

In physics, clapotis are considered to be transverse waves because they can rise up. In other words, they travel up and down in a two dimensional plane. Consequently, clapotis cannot occur in rigid containers, such as water pipes in homes, because rigid containers can’t expand and allow the wave to rise. Instead rigid containers cause longitudinal waves. Longitudinal waves are caused by alternating compression and expansion of fluids or air within a confined space. For example, longitudinal waves occur in muscial instruments that use pipes to make sound. In contrast to transverse waves, longitudinal waves travel in one plane.

Unlike standing waves, water hammers occur in rigid containers, such as pipes, when a forceful stream of moving water is suddenly stopped.  The rapid change in velocity causes a collision similar to a standing wave but the outcome is different. Because the wave cannot increase in height it causes compression (a longitudinal movement), which increases pressure that travels back through the pipes. The stiff pipes absorb the energy, which causes them to shake along their course. Unlike the “s” at the end of clapotis, water hammers are not silent. They make a loud banging noise like someone hammering on the plumbing. Over time, water hammers can break pipe joints.

When it comes to standing waves and water hammers, the latest research is starting to connect faulty cerebrospinal fluid (CSF) flow with the cause of neurodegenerative diseases such as Alzheimer’s, Parkinson’s and multiple scleriosis, which is the subject of my book, “The Downside of Upright Posture”. I started looking into the role of CSF in neurodegenerative diseases about thirty years ago because of my background in upper cervical chiropractic and craniopathy, which led me to the subject of physical anthropology.

Upper cervical chiropractic taught me the importance of the upper cervical spine and base of the skull to human health. Craniopathy taught me about the design of the human skull and the movement of cerebrospinal fluid through the brain and cord. Because of craniopathy, I also became interested in the base and sutures of the skull. In particular, I became interested in the sutures that unite the membranous bones of the skull that form the cover over the cranial vault, which contains the brain.

The picture above on the left shows the sutures at the back and bottom of the skull. Like all bones, the sutures are a reflexion of the mechanical stresses that strained and shaped them. Early anatomists called them sutures because they thought they looked somewhat similar to surgical stitches. But to me they look more like waves and they are shaped that way for a reason. They are similar to a seismic recording of pressure fluctuations and movement in the skull and cranial vault. The pressure fluctuations come from a combination of neurological (electrical), circulatory and respiratory waves. Upright posture and bipedal walking further amplify those waves.

CSF is a watery fluid produced in cavities of the brain called ventricles.  CSF flows out of the ventricles and into the cisterns and subarachnoid spaces of the brain and spinal cord. The role of CSF is to cushion, protect and support the brain to prevent it from sinking inside the cranial vault. It also carries waste out of the brain.

CSF is under constant fluctuating hydraulic pressures due to the pumping of the heart which increases arterial pressure in the brain when it contracts. Likewise, breathing causes changes in pressure inside the ribcage. During exhalation pressure inside the ribcage increases. Among other things this increases venous pressure which is transmitted to the vertebral veins. The vertebral veins are connected to the dural sinuses of the brain and like the dural sinuses, have no valves to prevent inversion (reverse) flows. Consequently, respiratory pressure changes are transmitted to the brain and exhalation increases intracranial pressure.

Because the cranial vault is a closed container, the increase in blood volume and intracranial pressure needs to be controlled. When things are working properly, any excess CSF volume and pressure is typically vented out of the cranial vault via the foramen magnum and down into the subarachnoid space of the spinal canal. Inherited (genetic) and acquired (aging and injuries) structural problems in the cervical spine can cause back pressure against the venting mechanism. If outgoing CSF waves meet resistance or inversion flows of blood and CSF waves coming up from the vertebral veins and subarachnoid space (contains CSF) in the spinal canal then clapotis (standing waves) or water hammers can occur.

In the sketch above on the right, the brain is like a landmass inside the cranial vault surrounded by a sea of CSF and venous blood in vessels with no valves to prevent inversion flows. The skull is a fairly rigid container. Consequently, the amplitude of any standing waves (clapotis) in the brain is limited. Thus the standing wave that occurs as CSF in the brain claps into CSF in the cord as it attempts to flow through the foramen magnum and out of the cranial vault becomes more like a water hammer.

In either case, the first areas of the brain to receive the brunt of either clapotis or water hammers are the basal cisterns that surround the cerebellum and brainstem. It is possible that over time, chronic clapotis (standing waves) or constant banging from water hammers in the basal cisterns weaken and eventually erode the soft tissues of the brain the same as rocky coasts.

Similarly, I suspect that standing waves and water hammers may also play a role in the formation of arachnoid cysts and empty sella syndromes, as well as the Dandy-Walker and Shy-Drager syndrome (a variant of Parkinson’s disease) type cysts seen in the ventricles and cisterns.

For a better understanding of the big picture read my book. For further information visit my website at www.upright-health.com.

Posted in Alzheimer's, arachnoid cysts, chiari malformations, CSF, Dandy-Walker syndrome, dementia, demyelination, Devic's disease, Ehlers Danlos Syndrome, empty sella syndrome, ms lesions, multiple sclerosis, neuromyelitis optica, optic neuritis, optic spinal multiple sclerosis, Parkinson's, physical anthropology, spondylosis, syrinxes | Leave a comment

The Missed Measure of Man

The Mismeasure of Man, an oft-cited work criti...

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The missed measure of man was overlooked during earlier investigations of human cranial capacity that focused on its relationship to intelligence. That is what the book to the right set about to disprove. Unfortunately, the subject of cranial capacity due to it’s ties to human intelligence has since become taboo to discuss due to political correctness. This is unfortunate because cranial capacity may play a key role in neurodegenerative diseases such as Alzheimer’s, Parkinson’s and multiple sclerosis and has nothing to do with intelligence. The missed measure of man that was overlooked is the design, layout and capacity of the posterior fossa in particular.

Some scientists once believed that there was a direct correlation between cranial capacity and human intelligence. It is a myth I cover in the last chapter in my book. The first problem is that there is no direct linear correlation between brain size and intelligence. If there were then elephants and whales would be smarter than humans. Similarly speaking, parrots have small cranial capacities but are far more intelligent (due to the way we test intelligence) than many mammals with much larger brains. Furthermore, regardless of race, females tend to have a smaller cranial capacity compared to males and Einstein, who was considered by many to be a genius, had an exceptionally small cranial capacity. In fact, his cranium was at the very low end of female capacity.

There is another problem and that is the way we measure intelligence. The brain is a survival organism. It’s job it to help us manipulate and master our environment. IQ tests are prejudiced against indigenous people who must master and remember many things about their environment and rely on ingenuity to survive and thrive. IQ tests fail to measure the subtleties and full spectrum of human intellect such as creativty, imagination and intuition among other things. Instead, modern IQ tests measure abstractions and memory in ways that may be important to people living in industrialized socities but are useless to indigenous people. Many people with so called high IQ’s wouldn’t be able to survive in similar circumstances. The bottom line is that the correlation between IQ and cranial capacity doesn’t work.

Presumably there are about one hundred billion nerves cells in the brain. Interestingly, the cerebellum sits in the posterior fossa and has more nerves that the rest of the brain put together. The truth is no one has actually counted. It is simply a guess based on average brain weight, the amount of fat and other factors. The average brain in humans weighs 1300-1400 grams or about 2.75-3.5 pounds. About half of it is fat. The rest of it is nerve cells. As far as we know for now, until proven otherwise, all humans are born with roughly the same number of nerve cells in the brain give or take a few billion or so. Bigger heads simply have bigger brains with larger nerves and more fat, not necessarily more nerves.

Nonetheless, a great deal of time and energy was wasted at the time measuring the size of the head and the capacity of the cranial vault. The famous book by Jay Gould pictured above was published in 1984 called The Mismeasure of Man. In it Gould refutes the arguements of the day, some of which were racially motivated.

Disregarding the old ignorant debates about cranial capacity and intelligence, there are many important issues to consider when it comes to race, gender and health. Just as females and males have different health concerns, certain health conditions have a higher incidence in particular races and ethnic groups. For example, thalasemia and sickle cells affect Asians and Africans far more than northern Europeans. Europeans living on the Mediterranean, however, are likewise effected. Thalasemia and sickle cell anemia are believed to have been protective mechanisms against malaria. The downside is they predispose afflicted people to anemia. Just as blood cells affect our physiology so does the design of the skull.

It is easy to see racial differences, including mixed races, simply by looking at the face. In this regard, it is interesting to note that the design of the facial part of the skull is intimately connected to the design of the base of the skull. They grow together during development and have a strong influence on one another. Their growth in childhood follows the musculoskeletal system of the rest of the body.

Together, the face and base of the skull determine the basic layout of the floor of the cranial vault. The bones that form the curved walls and cap the top of the cranial vault follow the growth of the brain. The cover over the cranial vault stops growing early in life when the brain stops growing in size.

There are significant racial and gender differences in the incidence of multiple sclerosis. There are also geographic differences but that’s a different story. When it comes to race, people of Asian and African descent appear to have a distinct advantage in that they appear to have a much lower incidence of MS than European people. When it comes to gender, regardless of race, females appear to have a distinct disadvantage in that they have a significantly higher incidence of MS compared to males. The difference in incidence in both race and gender may be due to design diffferences in the posterior fossa.

The white lines in the brain scan above represent the outline of the posterior fossa. The top line is missing because it represents the opening in the covering over the posterior fossa. The covering is called the tentorium cerebelli. The opening is called the tentorial notch or incisura. The scan is from a paper called, “Dimensions of the posterior fossa in patients symptomatic for Chiari 1 malformation but without cerebellar tonsillar descent,” by Sekula et. al., published in Fluids and Barriers of the CNS in 2005.

Among other things, a smaller or hypoplastic posterior fossa is more susceptible to Chiari malformations. In this regard, females most likely have a smaller posterior fossa compared to most males. They also have a higher incidence of multiple sclerosis compared to males.
Up until the eighth decade, they also have a higher incidence and get Alzheimer’s sooner than males. Females are also far more susceptible to Chiari malformations and to Dandy-Walker syndrome. Dandy-Walker syndrome, as you may recall, is related to enlarged ventricles and cysts that effect CSF flow mentioned in the previous post. The increased incidence of these particular conditions in females may have to do with the design of the posterior fossa, especially its capacity.

When it comes to race, a fairly recent orthodontic study on racial differences in craniofacial design done in Scotland showed that Europeans tend to have a shorter clivus in the base of the skull. This is interesting because a shorter clivus could decrease the capacity of the posterior fossa in Europeans compared to Asian and African designs. Thus, if the old arguments regarding a correlation between cranial capacity and IQ were true, then European brains would have fewer nerves compared to Asian and African brains. In addition to the capacity of the posterior fossa, other design issues to consider are the angles and pitch of the clivus and the tentorium cerebelli, as well as the angle of the base of the skull to the upper cervical spine.

Another issue to consider is, although they don’t get classic MS, Asians and Africans do get optic spinal multiple sclerosis and Devic’s disease. What’s more, Devic’s tends to be relatively more severe and disabling. Both optic spinal multiple sclerosis and Devic’s may be variants of multiple sclerosis due to design differences in the posterior fossa.  The problem may lie in our method of diagnosing MS, which is based on classic lesions. Apparently, Asian and African people don’t get classic lesions. Aside from that, they otherwise get similar signs and symptoms. Consequently, many cases of MS among African and and Asian races may have been and continue to be overlooked and marginalized.

In addition, the condition of hydrocephalus is as old as the human race. It started with standing upright. All races are equally susceptible. Lastly, as we continue to learn more from upright MRI, just as I predicted in my book, it appears Chiari malformations also referred to as cerebellar tonsillar ectopia (CTE) are far more common than once thought. They can occur later in life due to trauma, aging and misalignments of the upper cervical spine that cause the brainstem to get pulled down or to sag slightly, due to low pressure, toward the base of the skull and into the foramen magnum. Tethered cords from a genetically short cord or from degeneration and abnormal curvatures of the spine can also cause CTE. Humans are susceptible to CTE by design and CTE can cause hydrocephalic-like conditions. Furthermore, hydrocephalic conditions and CTE may be at the core and cause of many neurodegenerative diseases. One of the causes lies in the design, layout and capcity of the posterior fossa. Other causes will be discussed as my blog and website continue to grow. For further information visit my website at www.upright-health.com.

Posted in Alzheimer's, arachnoid cysts, chiari malformations, cranial capacity, CSF, Dandy-Walker syndrome, dementia, Devic's disease, human intellect, measure intelligence, multiple sclerosis, neuromyelitis optica, optic neuritis, optic spinal multiple sclerosis, Parkinson's, physical anthropology | 5 Comments