Fascinating research coming out of Pittsburgh's Allegany General Hospital. Arterial compression of nerves inside the penduncle area of the brain appears to trigger Parkinson's in many patients. This is noted on MRI, and a surgical treatment, called microdecompression, is used to open up the brain, relocate the nerve away from the offending artery and symptoms remit.
Here is the complete paper
available in pdf form online:
http://www.pagepress.org/journals/index.php/ni/article/view/ni.2011.e7
from the paper:
Beginning in 1966, a growing number of cranial nerve and brainstem syndromes have been reported to be caused by pulsatile vascular compression, arterial or venous or both. These include such apparently disparate problems as trigeminal neuralgia3-5 (both typical and atypical), hemifacial spasm,6,7 Meniere’s disease,8 disabling positional vertigo,9 glos- sopharyngeal neuralgia,10-12 Bell’s palsy,13 essential hypertension14-17 and type 2 diabetes.18,19 This knowledge of the above entities, although known and accepted in the neurosurgical community, have not penetrated into the general medicine literature.
Here's a description of this open surgical procedure, called microvascular decompression (mvd)---
http://www.mayfieldclinic.com/PE-MVD.htm
The one woman who had this procedure done on one side, had almost instant relief of her Parkinson's symptoms, BUT she developed arterial compression on the other side, 18 months later..and her Parkinson's returned. Why would this happen? Why would the other cerebral artery grow to compress the nerves on the opposite side?
Perhaps there is a connection to CCSVI, and the real problem is further down river, in the neck. Dr. Zamboni has stated that CCSVI is in MS alone, and that Parkinson's does not have the same venous parameters. But perhaps there is a similar component, due to slowed venous drainage.
Let's see if there's any logic in the following. Since the extracranial veins are taking longer to remove blood from the brain, the heart and arteries are compensating by sending more blood in. Here is a note I posted on Dr. E. Mark Haacke's research into flow quantification in CCSVI.
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Dr. E. Mark Haacke is another hero who spoke at the Hubbard conference regarding new research. He continues to refine his protocol and find new ways to compare blood flow in and out of the brains of normals (controls) vs. pwMS and CCSVI.
One means of visualizing this difference is with blood flow quantification. Measuring the actual speed and volume of blood going into and out of the brain. Dr Haacke is now teaching other researchers how to do this. MRV stagnent images of veins may look just fine to researchers...but once flow quantifications are done, it is obvious these veins are NOT NORMAL.
Dr. Haacke discusses this in the YouTube video segment linked here:
http://www.youtube.com/user/HubbFound?blend=7&ob=5#p/u/7/8QpxR1nHOIg
six minutes in....
"We can get the cross-sectionals for every vessel...we can calculate the total cardiovascular input into the brain and the venous out put from the brain. Here's a case of normals, where we're looking at the major veins, they flow at about 10cm per second. They don't have these wild swings associated with them. Here's a case.... all four of the major veins in this individual have come to almost zero or reflux flow, and so because of that, in order to get that blood out, talk about a stress on your system, the flow has to double in the 2nd half of the cardiac cycle and becomes 20 cm per second in order to get it out. I've actually seen flow as high as 60 cm per second in an MS case because of this type of problem."
0 cm. of blood on this first half of the cardiac cycle, then 20cm on the second half. 60 cm of blood in a pwMS. This is NOT NORMAL.
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And here is the wonderful Clive Beggs explaining fluid mechanics, pressure difference and cerebral blood flow.
"Fluids are dumb, they take the path of least resistance." Here is his wonderful video from Dr. Sclafani's conference. He shows how hypertension and hypoperfusion are related:
https://www.facebook.com/photo.php?v=909845160843
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Perhaps this irregular fluctuation in the blood flow during the cardiac cycle could create slight "swelling" or distension in the cerebral arteries. which would then compress adjacent nerves....this could be why some IRs are finding CCSVI in people with Parkinson's and venoplasty treatment is helping. Corrected venous return would eliminate stalled blood flow, arterial hypertension, and decrease the size of arteries inside the brain, which might be one manifestation of CCSVI and its affect on the brain. And maybe an intracranial surgery could be avoided with less invasive venoplasty.
It is certainly something to think about. Sending up the bat signal to the Hubbards! I hope they can invite these wonderful researchers to the ISNVD conference in Orlando next February.
Joan
