Cranio-cervical trauma and MS

Damadian & Chu. The possible role of cranio-cervical trauma and abnormal CSF hydrodynamics in the genesis of multiple sclerosis. Physiol Chem Phys Med NMR. 2011;41:1-17.

Upright multi-position MR scanning has demonstrated a set of new observations in a small number of MS’ers. The upright MRI has demonstrated anatomical variation in the cervical (neck) spine in 5 of the MS’ers studied and cervical (neck) pathology in the other 3. The pathology is claimed to be due to prior head and neck trauma. 

The authors state that all 8 MS’ers entered the study on a first come first serve basis without priority, and all but one were found to have a history of prior cervical trauma which resulted in cervical pathology. The cervical pathology was visualized by upright MRI. 

Upright cerebrospinal fluid (CSF) cinematography and quantitative measurements of CSF velocity, CSF flow and CSF pressure gradients in the upright patient revealed obstructions to CSF flow in all of the MS’ers studied. 

In all but one MS’er, anatomic pathologies were found to be more prominent in the upright position than in the recumbent position. Similarly, CSF flow abnormalities were found to be more prominent in the upright position than in the recumbent position in all but one MS’er. 

“The abstract of this paper is poorly written and difficult to draw definitive conclusions without reading the paper. Unfortunately, I don’t have access to the full paper at present to make an informed comment at this time. However, I have concerns about the paper. The investigators state that all the MS’ers in this study have had significant trauma; therefore these findings cannot be generalised to other MS’ers as a history of preceding trauma is rare and many studies have excluded trauma as a relevant risk factor in MS.”

“Clearly this work will have to be reproduced; I plan to ask my neuroradiology colleagues to comment on it and I will get back to you on the blog.”

“I am not sure what treatment these authors are proposing; but please don’t rush to get your scanned in an upright scanner and have treatment until we get some informed feedback from experts in the area and the findings are reproduced.”

“It sounds as if the scanner used in this study is propriety or a specialised scanner, which means it will not be widely available for general use.”

10 thoughts on “Cranio-cervical trauma and MS”

  1. Re: "What do you mean by MS trauma? Is that like the damage to myelin and stuff?"No, like whiplash or sports injuries to the neck.

  2. My wife was diagnosed with a herniated disk prior to being diagnosed with MS. In fact, it was the surgeon that put the neuroligist on the path of looking at MS, when he refused to operate. Basically said the Neuro's initial diagnosis was wrong. After ~6 years on copaxone, my wife decided to go off of DMD's over 4 years ago. We've seen no adverse effects from the decision. Rather, there appear to have been improvements in some areas. I've always questioned the process we went through.

  3. So, would you consider abnormal CSF flow completely irrelevant to MS? What about the Monro-Kellie hypothesis?

  4. Re: "So, would you consider abnormal CSF flow completely irrelevant to MS?" No, it may explain the distribution of the lesions. "What about the Monro-Kellie hypothesis?"The Monro-Kellie hypothesis is a generic hypothesis that describes the pressure-volume relationship between intra-cranial pressure, volume of cerebrospinal fluid, blood, brain tissue, and the cerebral perfusion pressure. Apart for pseudo-tumoral MS lesions and brain atrophy, I am not aware of any other abnormality to perturb the relationship between the variables of the Monro-Kellie hypothesis. If you know of any literature please feel free to share it with us.

  5. Re "No, it may explain the distribution of the lesions."The distribution only? Not the cause? In what way?

  6. Gavin, Is there more information you have, more in regards of a injury or trauma such as a fall or injury to the cervical , neck, or head area.. that was diagnosed subsequently to be multiple sclerosis?

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