Cervical Spine Instability, Vein blockage, fluid build up and intracranial hypertension.

Ross Hauser, MD and Brian Hutcheson, DC 

We see many patients who have a serious health challenge in having intracranial hypertension. In many of these people, intracranial hypertension was not initially thought of as a problem as their doctors instead tackled the symptoms that these people were facing. Symptoms that included dizziness, headache, vision problems such as sensitivity to light where exaggerated pupillary hippus dilating and constricting which can cause problems with light sensitivity and the pupil fails to respond correctly to light sources. These people also faced symptoms and diagnosis of Tinnitus or ringing in the ears, neck pain, and tremors.

Once a problem of intracranial hypertension or a  build-up of pressure around the brain was discovered, a myriad of tests and treatments were tried. Once obvious causes such as head injury or stroke were ruled out, initial testing may have looked for causes in blood clots, infection, and tumors. Once tests ruled those out as causes your diagnosis of intracranial hypertension, you then got an updated diagnosis of idiopathic intracranial hypertension, which means no one knows why you have intracranial hypertension.

Researchers suggest tends to show that idiopathic intracranial hypertension affects women in their 20s and 30s. The characteristics these women display are very wide-ranging which makes a proper diagnosis difficult.

So what doctors look for are patients who are:

  • overweight or obese
  • have hormone problems  stemming from the adrenals or thyroid
  • have problems with medications or a combination of medications causing increased blood pressure
  • have anemia or lack of red blood cells or conversely, the patient is making too many red blood cells
  • autoimmune disorders
  • have headaches
  • have vision problems
  • coordination problems

Tests are ordered to look for problems with the eyes, CT or MRI of the brain and a spinal tap to check for high pressure in the cerebral spinal fluid surrounding your brain and spinal cord.

Once these tests are performed you may be given a treatment plan that includes weight loss, a review or reduction or repurposing of the medications you are on, you may be given medications to reduce the production of cerebrospinal fluid, steroids, routine spinal taps to remove excess fluid buildup.

Finally, when all these things do not work, a suggestion to surgery to plant a drainage tube may be recommended or surgery to help relieve pressure on your eyes. These of course are risky surgeries.

For many people, these treatments may have worked wonderfully. These are not the people that are contacting our office. We see the people that continue to have these symptoms and challenges despite years of treatment. So what is it that we can offer them? The possibility of a missing diagnosis. For some of these patients, not all, there is a problem of cervical spine instability causing a problem of cerebral spinal fluid drainage and buildup.

Cervical Spine Instability, Vein blockage, fluid build-up and intracranial hypertension.

Ross Hauser, MD and Brian Hutcheson, DC explain the problems of blurry vision, brain fog, and other symptoms seen in patients with intracranial hypertension and treatments to alter the cervical spine dynamics to relieve these symptoms.

Below the video is a summary of the transcription.

Summary transcript:

1:17 of video: Diagnosing high blood pressure in the brain. In our office is one of the few offices that can diagnose high blood pressure in the brain or intracranial hypertension. We can document the problem with:

  • Motional Venous Obstruction Mapping
  • Optic Nerve Measurements
  • Motion Arterial Obstruction Mapping
  • Cine phase-contrast MRI – imaging of the brain and brainstem in the supine and upright positions. This can show obstructions of cerebrospinal fluid (CSF) flow, as well as the accumulations of CSF in various parts of the brain and brainstem, compressing these structures and, thus, damaging them.

Please refer to our article on brain drainage testing for more information.

How does venous obstruction occur in a neck? 

1:17 of video: We are finding and doing outcome research on is the problem of what’s causing the cerebrospinal fluid flow to accumulate and cause pressure inside the head to be elevated is a venous obstruction (vein blockage) so how does venous obstruction occur in a neck?

1:52 of video: Elongating the amount of space that the vein has to travel in order to get to the head and back to the body.

One reason is that the vein is getting stretched out in the neck. How? One way is that the patient’s head is moving forward on their shoulders. When the head is in this position, the veins get pulled on and stretched out. This narrows the veins. A narrowed vein has less room for blood and fluid to flow in, this narrowing caused by cervical spine instability, which leads the head forward is characteristic of the problems faced with stenosis.

A balloon demonstration of a stretched vein

  • At 3:30 the vein is represented by a balloon. When the balloon is stretched to 9 inches it has more space for the blood to flow than when it is stretched to at 11 inches. A narrowing occurs. The more stretching of the vein the less space is contained within the vein for the blood flow and for drainage of fluids that need to be moved out of the brain.

A “sludge” buildup in the brain caused by malrotation at the C1

  • At 4:15 It is common that for patients to come in with brain fog there’s like fatigue that can’t get rid. A possible cause of this is that normal cerebrospinal fluid flow is backed up. This causes the fluid to move slowly and take on a sludge-like consistency.
Relationship of the internal carotid artery to the upper cervical vertebrae. The internal cartoid artery sits just in front of the transverse process of the atlas (C1) and the axis (C2). Even its blood flow can be constricted or blocked by atlanto-axial (upper) cervical instability.

Relationship of the internal carotid artery to the upper cervical vertebrae. The internal cartoid artery sits just in front of the transverse process of the atlas (C1) and the axis (C2). Even its blood flow can be constricted or blocked by atlanto-axial (upper) cervical instability.

The main danger of brain venous congestion is that it increases intracranial pressure, this pressure is then transmitted to the brain’s arteries, which then increase blood flow to ensure adequate oxygenation of the brain. If the blood vessels cannot respond because of their obstruction in the neck, then brain ischemia can ensue.

The brain’s blood vessels may initially be able to respond via autoregulation (increases in blood vessel diameter in the brain) for a time, but if the cervical/brain venous congestion continues because of cervical dysstructure and cervical instability, the increased intracranial pressure will eventually damage the brain neurons, and ultimately, the brain tissue itself.

While the most common cause of arterial or venous obstruction in patients seen at Caring Medical is narrowing caused by cervical instability, it can also be from autonomic nervous dysfunction. Autonomic nervous dysfunction or dysautonomia can cause detrimental changes in the arterial blood flow to the brain or venous blood flow out.

Loss of blood flow to the brain

Vision problems

  • When Intracranial pressure is increased you can get changes in your vision, you can get double vision or you can get graying of the vision. You can even see an image and you look away and you still see that image. There are all kinds of vision problems that are from upper cervical instability.
  • If you have vision issues and nobody can help identify the problem I suggest an examination for upper cervical instability.

A September 2020 study in the Journal of Neuro-Ophthalmology (1) noted that abnormal forces around the optic nerve head due to orbital diseases, intracranial hypertension, and glaucoma are associated with alterations of the optic nerve head shape. Elevated cerebral and ophthalmic venous pressure can contribute to stress and strain on the optic nerve head and peripapillary retina.

You can’t clear your head

  • When cerebral spinal fluid flow is disrupted, it’s almost it’s as if the brain becomes a toxic toilet. You need normal cerebral spinal fluid flow to be normal to flush all the toxins and all the waste products from all the activity of the brain out. If these is impeded flow you will suffer the problems of not being able to focus or remember. You feel like a brain fog has surrounded you. This can be caused by upper cervical instability.

In our article: How cervical spine instability disrupts blood flow into the brain, we discuss how cervical spine instability pinches on arteries and disrupts, impedes, and retards blood flow into the brain. This is one of the great challenges that face cervical spine or cervical neck instability patients. In our office, almost all the people who have upper cervical spine instability, who come in for our non-surgical treatments, have an amazing amount of brain fog, the inability to concentrate, anxiety, and depression. These are not the typical things that doctors look for in the neck. For more information, please continue with that article: How cervical spine instability disrupts blood flow into the brain

References:

1 Kupersmith MJ, Sibony PA. Retinal and Optic Nerve Deformations Due to Orbital Versus Intracranial Venous Hypertension. J Neuroophthalmol. 2020 Sep 11. doi: 10.1097/WNO.0000000000001074. Epub ahead of print. PMID: 32956232.

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