Cranio-cervical trauma and MS

C
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.”

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

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