MRI showing issues of hindered Cerebro Spinal Fluid (CSF) Flow – Hydrocephalus, Empty sella, etc

[Barbara]

For those interested in the Bolognese/Milhorat method I mentioned, here’s the paper:

Dr._Francomanos_article_CCI.pdf

[Barbara]

Here’s a picture of an earlier MRI scan I had, some years ago. I want to draw your attention to the Pituitary Gland, which is the grey part of the image encircled in red. The pituitary gland is the ‘master gland’ if you like, part of the central control for many hormones which carry out an abundance of essential tasks throughout the body. It is so important, that it lives in it’s own special bony chamber in the base of the skull.

In it’s normal state it looks like a bean. On a sagittal MRI, like the one below where the view cuts through the middle of it, it should look like a cherry with a stalk. In a child, that cherry part is normally 6mm high but in an adult it’s 8mm (or more, in childbearing age women – see Elster’s Rule).

The image I’ve chosen below shows a Partially Empty Sella and I have shown an enlarged ‘life-sized’ version alongside to help give it more clarity. This may help you identify this often missed condition, on your MRI, which is often responsible for many symptoms, that may be resolved with adequate treatment.
Barbara
(UK)

Attached files

[Barbara]

What causes this partially empty sella (and eventually a more fully blown empty sella) according to Dr Bolognese’s excellent video(s) on the Chiari Institute website, is the persistent pulsation of the raised intracranial pressure, acting as a ‘water-hammer’ on the pituitary.

[Barbara]

I have just been on The Chiari Institute’s website and the several links to the video’s are not working, so here’s a ‘work-around’, go to:-

http://www.chiariinstitute.com/Videos/index.html

This will present you with a video on ‘tethered cord’ (click [II] to stop it, or you’ll get distracted for 40 minutes, lol!).

1. To get to the video on the cause of an “Empty Sella”, at the bottom, on the toolbar, you will see [About][Patient Education][Conferences]. Click on [Patient Education]. It will present a new list of (excellent) videos.

2. Scroll down this new list of videos, to about 2/5 of the way down and you will find ‘Hormonal Problems on Chiari Malformation’. Click on this 10 minute video and it will explain how raised intracranial pressure flattens the Pituitary. (also how treatment – Diamox, surgery or whatever – can resolve the issues).

All these videos are very informative
Enjoy
Barbara

[Barbara]

Just heard about this new study (April 2014) about normal intra-cranial
pressures:-

http://thejns.org/doi/abs/10.3171/2014.2.JNS132209?prevSearch=&searchHistoryKey;=

So, in the upright position, it’s a negative value! Maybe that’s why
I’ve had to sleep (and remain) head-upright since my accident, to help
reduce the pressure as much as possible!

Barbara

[charlie1]

Thanks for all the information Barbara!

[Barbara]

You’re more than welcome Charlie1.
As you know, we all need as much useful knowledge as we can get our hands on, in order to improve our chances of survival. Many sufferers are too weak to research, or to speak up about their suffering, of those that speak up their voices alone, are all too commonly left unheard. We need that written evidence, or example of what to look for to give the doctors a starting point. I’ve been researching this condition for well over 10 years now, looking for these precious gems of information. Trouble is you have to sieve through an awful lot of ‘dross’ to find the diamond!

It would seem that complex multi-system issues have little (to no) representation, out there in the medical world, as the doctors ‘in the know’ are very few and far between. It’s down to us really, to get the word out as much as possible, in hope that maybe some inquisitive medical practitioners might take it up and run with it, for all our sakes!
Regards
Barbara
(UK)

[Barbara]

Some years ago, looking at my series of scans, I could see something was wrong but couldn’t quite explain it. It was like, when I was laid down, the mid-lower part of my neck sort of collapsed backwards, my upper neck seemed to be pushed forwards. This I now know is termed ‘Loss of Lordosis’ – lordosis being the natural ‘C’ shaped curvature of the neck bones.

My head was pushed upwards and sort of rotated frontally, if you get what I mean. I often woke up paralysed, with my chin on my chest. A position I was unable to put my head into before my accident. Wearing the Philadelphia collar and brace during the night, put an end to this and the night-time paralysis (thank goodness – it was horrific!).

I also noticed that my brainstem seemed to be being stretched. It looked like my hind brain (the cerebellum) was being scooped up by the back of my skull and hoiked upwards and forwards towards my brainstem.

[Barbara]

I also noticed that my brainstem seemed to be being stretched.

I should point out here that, when measurements were taken at The Chiari Institute in New York in 2008 (6+ years after my head and neck injury) it was noted that I had an ‘elongated brainstem’ thus further supporting my observations. Obviously the craniocervical instability was taking it’s toll on the underlying structures.
Barbara
(UK)

[Barbara]

I’ve just been checking the posts on Chiari for a friend and, for those who are particularly interest in looking at MRI’s, I came across another post where I annotated an MRI for someone, so I thought I’d post the link here:-

http://prettyill.com/forums/viewthread/864/#4070

There may be some additional useful information in that post.
Barbara
(UK)

[margaretreber]

Hi, I suggest you to take chiropractic treatment. This treatment is really effective. I know a good chiropractor, you can consult to them. visit
Chiropractor Chantilly, VA.

[Barbara]

Hello,
Unfortunately since my accident, I’ve always felt ‘too fragile’ to dare let anyone manually manipulate my head neck junction but, I must admit, the very first account of symptoms that most matched mine, were written I think by a guy called Greg Buchanan who sang the praises of upper cervical ‘specific’ chiropractic, see his website at:-

http://www.upcspine.com/intro.htm

Also, when trying to find out the biomechanics behind my injury, I was helped a great deal by a chiropractor who carried out a ‘motion study’ on my cervical vertebrae x-rays. He kept them overnight as it took some time and, by overlaying the x-rays with sheets of acetate and drawing around each bone and comparing the bones in each of the 3 x-ray positions (neutral, flexion and extension), he determined which bones where moving as they should and which bones were problematic. It was a very useful study which helped me to understand how my neck motion had been affected.

Taking the knowledge of this method, which he was kind enough to teach me, I personally took the study one step further and looked at the neck-head (atlanto-occipital) relationship and that’s what started me looking in more depth at my radiology, as it was obvious to me that something was not quite right with the head-neck relationship. I was eventually diagnosed with cranio-cervical instability.

So, all-in-all, I have an awful lot to thank the chiropractic fraternity for – because none of this had been forth-coming from the general medical fraternity.
Regards,
Barbara
(UK)

[Barbara]

I have recently come across the file I kept of all the measurements that I took, whilst examining my own radiology, when researching Cranio-Cervical Instability (CCI) way back in 2007/2008. I’ll try and find the associated MRI’s/x-rays and upload a few examples over the next few weeks, for anyone interested in checking their own MRI’s etc.

I’ll try to show how some of the methods hospitals use, totally miss the problem. I’ll also try and explain the previously mentioned (and more comprehensive) method, created by Drs Milhorat, Bolognese, Nishikawa, Francomano etc., published in Dec 2007, to make it easier to understand . . . . . . so watch this space!

I wish a Happy New Year to everyone and wish you all the best,
Barbara
(UK)

[MJ]

Hi Barbara.

The empty sella…is that just the curved part your red line points to?
What about the bright spot just yo the right of that?
My MRI has an extremely bright white spot there.
Do you know what that is?
Is it related to the empty sella, or something different?

Thanks, MJ

PS I just found a hard bump behind my right ear, and when I press on it the entire right side of my head kills with lots of pressure, and severe pain travels down the back of my neck on that side. Also, lots of pain surrounding my entire ear area when I press on it. Any ideas?

[Barbara]

Hi MJ,
I’d see your doctor about your ear, it’s not something I’ve experienced sorry, so I can’t help you on that one.

Regarding the MRI of the pituitary, on the very first page of this topic I think the MRI is what’s called a ‘T1 weighting’, which portrays fluid as dark, whereas if you look at the post at the top of page 3 (this page?) you will see a ‘T2 weighted’ image, showing the fluid as light. The grey area here is the pituitary. These images were taken at different times. In this one on page 3, you can clearly see the extent of the fluid above the pituitary, within the sella turcica.

Regarding the bright spot at the back of the pituitary, on the image on page one, I’m unsure what it is, though I have seen it many times on others MRI’s. Many moons ago, I read about a bright spot in the optic chiasm – but as far as I remember, that’s higher up. Does anyone else know what this bright spot is ?
Regards
Barbara
(UK)

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