Getting to the Root Causes of Neurodegnerative Diseases
C1, C2 and CSF Flow
Upright MRI
Cerebrospinal fluid (CSF) flow is called the third circulation of the brain and it is the least understood. CSF production and flow is critical to brain cushioning and protection. In terms of protection CSF is important to brain support to prevent the brain from sinking in the cranial vault. Conversely, excess CSF volume compresses the brain.
CSF comes from arterial blood that has been filtered through the blood brain barrier to the point where it is mostly water. CSF leaves the brain through the venous system. Therefore, backups in the venous drainage system affect cerebrospinal fluid (CSF) flow and drainage. Although it uses other routes as well, such as cranial and spinal nerves and the lymphatic system, most of the cerebrospinal fluid (CSF) produced by the brain eventually makes its way up to the superior sagittal sinus where it empties into the venous system.
Arachnoid Granulations
About sixty percent of the CSF produced in the brain ends up in the spinal cord. Eventually most of the CSF in the spinal cord makes its way back up through the subarachnoid space of the cord and into the subarchnoid space of the brain. From there it travels up to the superior sagittal sinus and arachnoid granulations to exit the brain along with venous blood.
The movement of CSF is driven by cardiovascular waves arising from the heart and blood vessels. During the contraction phase of the heart cycle (systole) pressure in the arteries of the brain increases. The increase in blood pressure drives CSF out of the brain through the upper cervical spine because as blood volume rises CSF volume must decrease. During the relaxation phase (diastole) the pressure drops and CSF enters the cranial vault through the subarachnoid space of the upper cervical spine. In addition, because the veins of the vertebral venous plexus of the spine have no valves, respiratory pressure changes are transmitted to the brain and amplify the cardiovascular waves. In brief, as pressure in the chest cavity drops during inspiration, due to the diaphram moving down and the chest wall moving out, CSF is pulled out of the cranial vault. As pressure in the chest cavity increases during exhalation CSF is driven into the cranial cavity. Thus, combined cardiorespiratory waves are important to the movement of CSF through the brain and cord.
C1 & C2 Misalignment
Genetic design flaws, such as Chiari malformations, and acquired disorders from injuries or disease can impede the pulsatility and flow of CSF through the upper cervical spine. Restrictions in CSF flow that cause a decrease in its volume, can, in turn, cause Chiari malformations and pressure conus conditions. Furthermore, any condition that restricts CSF flow can lead to hydrocephalus-like conditions. It is therefore important to maintain the correct volume of CSF in order to provide sufficient brain support and protection, as well as to prevent hydrocephalus.
The picture above shows a fairly severe rotational misalignment of the upper cervical spine to the right. Click on the image for a better view. The dart shaped structure in the upper cervical spine is the spinous process of C2. It should be in the midline. The misalignment was caused by a motorcycle accident in which the victim landed on the right side of his head causing his head to snap to the left while simultaneously shifting and twisting his upper cervical spine to the right. Misalignments, such as the one above (due to micro or macro trauma), genetic design flaws (Chiari malformations), diseases (rheumatoid arthritis) and degenerative conditons (aging) of the upper cervical spine can affect the vertebral arteries that supply the brain, as well as the vertebral veins that drain the brain during upright posture. They can also cause deformation of the subarachnoid space and consequently, they can affect CSF flow going into and out of the brain and cord.
While CCSVI treatment can improve venous drainage, which may further relieve hydrocephalic conditions in certain cases, it cannot improve CSF flow through the subarachnoid space of the upper cervical spine. Furthermore, increasing venous drainage of the brain and consequently decreasing CSF volume without a proportionate rise in passive CSF production could compromise brain support causing it to sink in the vault resulting in a condition similar to a pressure conus or Chiari malformation. Over drainage of the brain may thus present problems similar to spinal taps which can cause headaches due to a pressure conus condition following CSF removal. Over drainage is probably less likely in younger cases where the passive CSF pressure gradient and CSF production remains strong. Older patients, on the other hand, may have a lower CSF pressure gradient and thus a decrease in passive production of CSF due to aging of the brain and chronic craniocervical back pressure against the vertebral veins and subarachnoid space.
The flow of CSF clearly plays a role in normal pressure hydrocephalus (NPH), which has been associated with Alzheimer’s and Parkinson’s disease. It also plays a role in Chiari malformations, which cause signs and symptoms similar to MS. I discuss CSF production and flow thoroughly in my book. I will be discussing it more here in future posts as well as on my new website at: http://www.upright-health.com/.
This entry was posted in Alzheimer's, ccsvi, chiari malformations, Devic's disease, multiple sclerosis, neuromyelitis optica, optic neuritis, optic spinal multiple sclerosis, Parkinson's, physical anthropology. Bookmark the permalink.
The effects caused by low BP as well as alignment are of interest to me as we have discussed on TiMS . If there are also valve malformations or compression by muscles and tendons in/on the veins draining the brain which will alter the bloods ability to drain freely/unrestricted this whole process of CSF would be compounding the symptoms of my MS arising I presume?
Regards Nigel
Absolutely. In your particular case, however, I think the problems are more related to the vertebral-basilar artery ischemia than CSF flow. In either case the technology is here now to test both blood and CSF flow.
As you likely know, many patients with Ehlers-Danlos Syndrome (faulty connective tissue; also called EDS) tend to develop M.S., and I wonder how many M.S. patients also have EDS (I know quite a few). I believe that EDS patients may benefit from your knowledge also, as the majority develop autonomic dysfunction and numerous symptoms of M.S. without the classic brain lesions.
May I ask you if poor drainage could ultimately result in left ventricular diastolic dysfunction, possibly because of the inability of the heart to continue to try to push out arterial blood into a loop that is already stagnant (due to poor veinous drainage)? Many of us are developing this condition and we are trying hard to figure out why, and what to do about it.
Thank you so much, Dr. Flanagan. You are a blessing to us all.
Fondly,
Dr. Diana
All this just brings to the forefront how nothing is isolated in the body, and this fact has to be kept paramount in any approach to healing.
I see my chiropractor next week, and will surely bring up this info re: high blood pressure and subluxations–particularly in light of fact I’ve had several severe injuries to neck and head, contributing much to the various problems I’ve been having over the years. Also have had very bad dental work done, resulting in TMJ, which the chiro is working on (as is my neuromuscular dentist). She has helped greatly with the TMJ–possibly varying her adjustments will help with the BP…
Excercise increases cardiovascular waves and the ripple effect in the brain.
May I ask another EDS question? Many of us with loose joints have problems with our tail bones going out of alignment, too. I had a vague understanding that there may be some sort of CSF pump-effect in the sacral region. Have you ever heard that?
Also, what are your thoughts on cranio-sacral massage received in attempt to assist in CSF flow? It sounds like such a good idea, as long as the masseuse doesn’t mind following us around to continue the massage throughout the day!
Thank you, Dr. Flanagan :)
Actually, when applied correctly, craniosacral methods can be used effectively to correct mialignments of the spine. The problem is analysis of the misalignment. As it is currently practiced, craniopathic lesions (misalignments) are higly subjective and difficult to substantiate.
I would like to thank you for sharing your expertise with those of us without medical degrees. Sometimes it does feel as if the doctors I have dealt with only want to provide me with very basic information and would rather that I remained completely uneducated in their realm of expertise so then I will not question their diagnoses.
But as an historian research is in my blood :)
I posted under another thread, but upon reading the brilliant information above I wonder if this is a more appropriate field for my question. Especially given that when I viewed my pelvic xray I noted that the sacral arcuate lines were asymmetrical and not continuous, and I have been having hip and flank pain.
I have copied my original post below, thank you very much…
Hi Dr Flannagan
Six months ago I caught what the hospital considered to be a virus on my return from China that played havoc with my immune system and lowered my WBC to 2.1. Since then I have been suffering from fatigue and hip/flank pain which radiates down the back of my legs (a pelvic xray showed no abnormality), three weeks ago a swelling occured at the base of my skull which at the inital time resulted in nuchal ridgidity and severe pain. Xrays and a head CT could find no reason for the swelling. The pain has since subsided but when I put my chin on my chest there is a swollen line about 1cm wide (the only way I can think to explain it) that extends from one third up my neck and directly up into my skull, so much so that I am unable to feel any of my upper cervical bones, only this cord? Even with my neck in a normal position I am unable to feel upper cervical bones, just the ligament?
The many doctors I have seen have never seen this before, but as I am no longer in any cervical pain and because my WBC has improved to 4 they have told me not to worry and that perhaps my symptoms can be explained by a post-viral syndrome.
As this swelling, or whatever it is, is not usual and there has been absolutely no change in the size of the ridge on my neck at all since it first came up, I would quite like to find an explanation for this. I would like to ask if you could kindly let me know it you have you ever come across this kind of medical symptom before?
Thanks
My wife has MS and confirmed venous blockages in the left and right IJV and the azygos. She has had multiple venoplasties with some significant benefit, but we’re not quite there yet. She feels like something is being missed. I find your theory interesting and would like correspond with you privately.
What is the best way to do so? You have my Email.
Thanks
I have an arachnoid cyst at T3 which i think is blocking fliud and nowe have been told i have possible MS with no brain lesions, but one lesion at T8 and obands in my fluid. That was 2 years ago and i did not take any meds…since then i went to upper cervical dr. who said my atlas was waaay off and said it should be at a 0 and it was at a 4 or 5…so she adjusted it with the metal thing (not sure what it is called) and she got it to a 2 but the rest of my neck (which was already crooked) got even more crooked and now i have even more neck pain then i had. After that i also went to a reumotologis who said i have EDS so now i’m thinking i shouldnt have gottne my atlas adjusted like that. I don’t know what to do but i think has alot to do with what is going on in my CNS. I also have the tight muscle in my neck like the person who wrote 2 above me. I have had it for a long time even before all this started.
Please help and is there surgery to fix my neck b/c if I have EDS no adjustments hold….when my neck feels better my lower back/hips hurt really bad and i have lots of nerve pain in my thighs…Could the thigh pain be caused by my hips?
Thanks!!!!!!!!
I replied previously but I don’t see it here so I will repeat myself. The arachnoid cysts can be removed surgically, drained or shunted but they are most likely not the cause of your symptoms. They do, however, suggest that you have fluid stress in the thoracic spine. Based on your symptoms, your EDS diagnosis, there is a good possiblity you have curvature problems in the spine causing the stress.
I don’t know what type of specific upper cervical method the doctor is using but most methods use the hands. Atlas Orthogonal uses a stylus device mounted on a stand set to specific angles with the patient lying on a special table in side posture on special headpiece set to the correct angle before the adjustment. It is a hands-free upper cervical method.
That said, you have many rheumatological, not neurological type complaints. You have neck pain, low back pain, hip pain and thigh pain. It sounds like myofacitis or fibromyalgia type symptoms, which makes sense in your case, especially if your have EDS.
In lieu of a good upper cervical chiropractor, I would suggest you try the best sacrooccipital (SOT) chiropractor you can find and get your full spine checked. You may have a twist in your pelvis and low back that will affect all the muscles of the spine up to the base of the skull. SOT is a gentle non-force method that balances the entire spine head to toe and it won’t hurt the EDS.
I would certainly give it a try before you consider more aggressive surgical intervention. If you need help finding someone in your area let me know.
MFDC
I have had multiple sets of x-rays taken of my cervical spine and one chiropractor (pettibon, not specifically upper cervical) says that my main issue is the C2 vertebrae while the other (NUCCA practitioner) is treating the Atlas and when I ask him if C1 and C2 need to be treated separately to resolve my issues he is insisting that the Atlas adjustment will take care of the rest. I am due back for a follow-up appointment in a few days and want to be able to get as much out of the appointment as possible but most questions I ask are answered vaguely and almost always with (….”it’ll get better, just give it time”). My main concern is that most NUCCA practitioners advocate treatment of the Atlas but some also mention that problems at C1 and/or C2 can be corrected using upper cervical methods which has me a bit perplexed. On one hand I am being told that the C2 vertebrae is what is wreaking havoc on my system (currently not seeing the chiro who saw the C2 as my main issue) while this other chiro (who I am currently seeing) is addressing the Atlas and failing to answer my question as to whether the C2 vertebrae is in alignment with the rest of the spine. To this point I am not noticing much relief in any of my symptoms (tight right traps, pain behind right shoulder blade, restricted rotation and flexion/extension in neck, some right lower back pain, right hip pain and some right ankle pain as well as lateral left knee pain) and my biggest worry is that the main problem (which could very well be C2 according to another chiro) is being overlooked because NUCCA doesn’t directly deal with the C2 vertebrae…. or at least it seems some list the C2 adjustment as a possibility and others do not, only the atlas. I appreciate any and all advice you can provide on this matter.
– Zach
I don’t know the specifics of your case, however, there are different schools of thought on which way is the best way to correct the upper cervical spine. While all methods take into consideration C1 and C2, most prefer C1 as the major and C2 as the minor when it comes to selecting which one to work on. NUCCA can indeed correct C2 by working on C1. I don’t know how long you have been under care or how many visits you have had. That said, while upper cervical correction does take some time, you should see steady progress and the NUCCA doctor should be taking post x-rays to check for degrees of correction. Your neck and shoulder complaints will most likely be the first things to improve.
Dr. Flanagan
Just recently i have been told that I have c1 and c2 compression. I have been trying to find information to see if it was caused by a birth defect since i have had no major injury to my neck or head. Is it possible?
-Jessie
It is definitely possible. You could have one of several types of genetic design problem such as assimilation or fusion of your upper cervical spine.
Two quotes of which, I think, the first must be right:
In brief, as pressure in the chest cavity drops during inspiration, due to the diaphram moving down and the chest wall moving out, CSF is PULLED OUT of the cranial vault. As pressure in the chest cavity increases during exhalation CSF is driven into the cranial cavity.
https://uprightdoctor.wordpress.com/
Consequently, CSF gets PULLED INTO the cranial vault during inspiration as pressure drops and pushed out on exhalation as pressure increases.
http://www.upright-health.com/cerebrospinal-fluid.html
Ton
Thanks for bringing the error to my attention. Actually the second quote is correct. Inspiration causes a drop in pressure in the ribcage, which decreases pressure in the brain called intracranial pressure (ICP). The decreases in ICP pulls CSF out of the ventricles and into the brain. Exhalation increases pressure in the ribcage and consequently ICP, which causes CSF to flow into the brain.
Good question. The answer is yes. Dr. Scott Rosa is doing research in Latham, New York and has shown Chiari 1 type cerebellar tonsil retraction using FONAR upright MRI before and after and Atlas Orthogonal correction.
There certainly could be a correlation with your symptoms and the information on these pages. What is particularly suspicious is that you describe “pressure” and the base of you skull and in your gums. There is a good possiblitly you have a problem with your upper cervical spine. Upper cervical malformations and misalignments can cause displacement and pressure on the brainstem, as well as obstruction to blood and CSF. The trigeminal nerve provides sensation for the gums. As a reuslt of the course it follows, the trigeminal nerve, is susceptible to displacement of the brainstem in the posterior fossa.
Although your symptoms could be due to pressure on the optic nerve, an aura is typically a problem with perception and interpretation of signals from the eye, which is performed by the occipital lobe. Pressure on the optic nerve tends to cause problems with vision itself, such as tunnel vision or blind spots. The occipital lobe gets its blood supply from the vertebral-basilar arteries, which travel through the cervical spine. Problems in the cervical spine, especially the upper cervical spine can affect blood flow in the vertebral-basilar arteries and cause migraines. The optic nerve, however, passes over the cavernous sinus, which containd the trigeminal nerve. The trigeminal nerve is the sensory nerve of the face, including the gums. You may have pressure in the optic nerve and cavernous sinus area. I would need to know more about your case but it sounds as though you have a cervical problem. If I were treating you I would want to see your MRI and CT scans but I would also want to see to plain veiw x-rays of your spine. I suspect you have had trauma to your spine, a malformation or a misalignment of your upper cervical spine.
You should start by getting some plain view x-rays of your cervical spine. You can have them taken by an orthopedic surgeon, a chiropractor or a radiology facility.
I am a young Chiropractor with a patient suffering from raised CSF pressure, and complications with the optic nerve. The patient has undergone several lumbar punctures but has had no relief and has been referred on to me. Would you have any particular suggestions regarding her care?
Many thanks,
B A
Unfortunately, I don’t know any surgeons who see the connection between Parkinson’s and NPH at this time. They do, however, recognize the association of enlargement of the fourth ventricle and cisterna magna in multisystem atrophy or olivopontocerebellar atrophy which is a variant of Parkinson’s. I will be covering MSA and OPCA in my next post. They are very similar to Dandy-Walker Syndrome seen in children. I suspect they are all related to faulty cranial hydrodynamics (fluid mechanics inside the skull). An upright MRI to check for a cerebellar tonsillar ectopia (Chiari malformation) and a Cine MRI would be helpful to determine if there is blockage, turbulance and inversion flows in the posterior fossa.
I want to thank you for providing us with this knowledge! I began to read your article and became so excited/relieved that finally, here was something that seemed to offer me the insight I have been desperately searching for. I am a 23 year old female and have been plagued with back problems and severe headache/migraines (have never been officially diagnosed whether they are headaches or migraines) for quite some time. I am 5 ft and about 93 lbs. I have noticed over the past year or so that things seem to be getting worse as far as my energy/focus levels and overall quality of life. I don’t feel like the same person I did just a few years ago. I just don’t feel right, I don’t feel this is the way my body should feel day in and day out. I have an appointment in just a few weeks with a primary care Dr so that hopefully, I can get on a good path (which I am sure will be a long one) to find some answers.
I’m hoping that you may just be able to offer me some advice or any insight. I was born with a subdural hematoma and when I wasn’t walking by the age of two my parents found out that I had mild cerebral palsy. Is it possible these could be linked? I was diagnosed then and no follow up was ever done. So to which extent that I was really affected by the mild cerebral palsy, I still don’t know. About 2 or 3 years ago my mother had noticed a visible curve in my spine. My right shoulder sits higher and the shoulder blade protrudes out more than the other. I have side to side curves from the lumbar vertebrae all the way up to the cervical vertebrae. Thankfully, the curves are not malicious and entirely debilitating. Most don’t see it until it is pointed out. I went to a chiropractor who said I had scoliosis but he never requested that I get x-rays. He also said that I have torqued hips and there is not much of a lumbar curve.
The worst is in the cervical spine, I can tell that either C3 or C4 is curved out to the right, and it’s hard telling what is going on with C1 or C2. When I turn my head to either the right or left and hold it there for about 10 seconds, the back of my head begins to throb. I recently went through a bout of headaches or migraines that lasted for about 2 consecutive weeks. This was abnormal for my pattern of headaches. I normally get them 3-5 days a week, not 12-13 consecutive days in a row. During this time, the throbbing was there when I would stand up, bend over, and even when I laughed at one point. The pain was so bad when I laughed it stopped me instantly from laughing. If my adrenaline or blood pressure seems to go up, I also get sever throbbing pain. My stomach is usually somewhat nauseated as a result. The pain in my head stems from the very back and bottom of my skull, with more pain concentrated on the bottom right side. It seems to radiate from there. When I open my jaw wide, it doesn’t crack but it almost feels like a hard shift that is somewhat painful. Recently, I have had 3-4 times where the back of my head will feel stunningly numb when I go to speak and it lasts for seconds and then goes away. Over the past 6 months I have been going through what I am assuming to be panic attacks however, I don’t have a history of them and they come on at times when I’m not thinking of anything stressful and a majority of the time I’m just relaxing. My heart sometimes feels like it flutters for no reason but during one of the first and worst of my attacks, my heart was not only beating hard (which I anticipate to happen during an attack) it was beating irregularly. I don’t have trouble with balance or feel dizzy however there are times when it feels like a spatial shift and it makes me feel spatially weird in my surroundings.
I saw a chiropractor for about 3 months. We saw great improvement during the first half and in his words I seemed to have “completely unraveled” as if I was sitting in his clinic in the same condition I was when I first started treatment. The treatments became more painful, he seemed less personable and didn’t try new techniques so I stopped going.
I know I need an MRI but I can’t help but to believe my headaches, fatigue, inability to remember information, and quality of life are related to my spine problems. Do you think I am on the right track? Also, do you have advice about how I voice my concerns about problems that could potentially be affecting my CSF to the Dr without them thinking I’m over analyzing? Though I want an answer to what ails me, I don’t want a quick one. Any kind of words would help, I know you don’t have an answer but I just want to know if I am on to something. Thank you for everything!
The subdural hematoma, cerebral palsy and your current condition may be connected. In any case, your migraine and other signs and symptoms are clearly related to your spine. It isn’t just CSF flow you should be concerned about but also blood flow to the brain and brainstem. You need a thorough assesment of your spine, pelvis and legs. You need to start with basic x-rays. If necessary brain and spine MRI scans should preferrably be done upright. The upright position will show if you have a mild Chiari (CTE). Upright posture also increases strains that magnify problems such as abnormal curves in scoliosis. You need to find a physician or therapist with expertise in scoliosis and musculoskeletal disorders.
Your welcome. It’s a pleasure to hear how you understand the topic. Brain flotation is important. Pressure cones can occur when CSF volume and pressure in the spinal canal drops relative to the cranial vault causing the brainstem to sink into the foramen magnum. Malformations and misalignments of the craniocervical junction (upper cervical spine) can cause obstruction to CSF flow between the cranial vault and spinal canal resulting in decreased volume in the cisterns that support (float) the brain. Have fun with your new shoes.