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CSF pressure influence on vestibular dysfunction

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Thane
(@mactavish83)
Active Member
Joined: 3 years ago
Posts: 6
Topic starter  

A few months ago I was diagnosed with a vestibular dysfunction ("superior vestibular nerve/utricle dysfunction"). Went for all kinds of tests, including a brain/C-spine MRI where the radiologists claimed everything was basically normal ("unremarkable").

Given that it's still a mystery to me as to how the vestibular dysfunction came about, I needed to keep investigating. Last week I managed to organize a Skype consultation with a foreign physiotherapist trained in reading medical imaging to review my MRI, and apparently my MRI isn't so normal after all. I have:

  • Potential blockage (not sure if intermittent or constant) of one of the important veins that drains from my brain into my jugular (the "sigmoid sinus vein").
  • Clear evidence of increased cerebrospinal fluid (CSF) pressure ("empty sella sign").
  • Tarlov cysts in my C-spine (apparently these can form when CSF pressure gets too high - they're basically bulging nerve roots).
  • My internal jugular vein is clearly being compressed by one of my vertebra (could be due to bad posture/weak neck muscles). This apparently can cause intermittent increases in blood (and therefore CSF) pressure inside my head.

According to this physiotherapist, in his experience, increased intracranial pressure can cause problems in the blood vessels in the vestibular system, causing vestibular dysfunction.

I've requested that my doctor ask one of the local radiologists to review my MRI again, so hopefully I can convince them to do some further investigation. Trouble is I don't have the typical signs of increased CSF pressure, which leads me to believe that it's an intermittent phenomenon (and more pronounced when my head/neck are in certain positions), so I get the sense getting a diagnosis is going to be tough.

Has anyone had any similar experience in developing a vestibular dysfunction from increased intracranial pressure, or this intermittent increased CSF pressure problem? If so, how did you go about dealing with it?


   
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(@andree-scollard)
VeDA Staff
Joined: 3 years ago
Posts: 18
 

Hi Thane,

While VeDA does not have any information on increased CSF pressure and vestibular symptoms, I did a little searching and found information on CSF increases as related to acoustic neuromas. You can see VeDA's information on acoustic neuromas here. If this is something that you are concerned about, please speak with your doctor. 

 

*Please note that VeDA does not have medical professionals on staff, so we are not qualified to diagnose or offer treatment suggestions.

Andrée Scollard, VeDA Patient & Family Resource Coordinator

This post was modified 3 years ago 3 times by Andree Scollard

   
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Thane
(@mactavish83)
Active Member
Joined: 3 years ago
Posts: 6
Topic starter  

Thanks Andree, but I've already had brain/C-spine MRIs and there's definitely no sign of an acoustic neuroma.

So far, from all the evidence, it looks like it's purely due to mechanical compression of my left internal jugular vein by my C1 vertebra. My neck's lost its natural curvature, probably from 2 whiplash injuries and many years' computer use/forward head posture, and so my C1's a few millimetres too far forward. I have other subtle signs of increased CSF pressure too.


   
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(@soniacn)
Active Member
Joined: 3 years ago
Posts: 27
 

@mactavish83

 

Hi Thane,  

I also have an issue with the C1 vertebra that was detected by some X-rays that my chiropractor ordered.  I've since been doing twice-a-week adjustments and subluxation therapy.  

Since doing the therapy my headaches have gone away, but I'm hoping that the dizziness also improves.  It's somewhat more tolerable, but it's still persistent.  

 

Have you started any therapy for the C1 vertebrae? 

 

Sonia


   
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Thane
(@mactavish83)
Active Member
Joined: 3 years ago
Posts: 6
Topic starter  

@soniacn thanks for the response! Have you ever had whiplash or neck injuries before that could've contributed to C1 subluxation?

So far, I've been working with a physiotherapist, and am now mainly focusing on strengthening the neck muscles at the back of my neck to help correct the position of my C1. My goal's to try strengthen the muscles that pull my C1 backwards and keep it there, just by even 1 or 2 millimetres (ideally 4mm), because that'll hopefully decompress my left internal jugular vein enough to restore good blood flow. My vestibular dysfunction is also on the left - same side as the compressed internal jugular vein.

Looks to me like strengthening my sub-occipital muscles (chin tucks, and variations on chin tucks), as well as my levator scapulae muscles (shoulder shrugs, external rotator exercises) seem to be helping so far. Also constantly being mindful of my posture seems to help. I seem to get the most immediate relief from careful sub-occipital muscle exercises, and slow shoulder shrugs with resistance bands.

The moment I lean my head forwards, or engage the muscles that pull my neck forwards (SCM, scalenes, longus colli, etc.), the dizziness/brain fog kicks in and I feel awful. I think this is where my C1 is pulled further forwards and compresses my internal jugular vein and wreaks havoc on my brain/vestibular system.

Apparently I may have "jugular outlet syndrome" - a relatively new term, by the looks of it. Kjetil Larson's been doing research on it, and it seems like it's a pretty frequent (and under-diagnosed) subtle condition that causes all kinds of diffuse problems (headaches/migraines, fatigue, intracranial hypertension, dizziness/vestibular dysfunction, etc.). Apparently many of the features of the syndrome on MRIs are ignored by radiologists, because they're so common.


   
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(@dr-joellehrer)
New Member
Joined: 3 years ago
Posts: 1
 

@mactavish83  Hi Thane.

   My reply has been routed not to your site but to mactavish83, but I hope that you see it.

Increased CSF pressure can be transmitted to the inner ear through the Cochlear Aqueduct.

The elevated CSF pressure can thus increase pressure in the Perilymphatic space and distort the inner ear fluid system

and cause dizziness, imbalance, hearing loss and pulsating tinnitus. It is more likely to occur in

overweight persons, but normal weight persons have been diagnosed and treated.

  There is literature on this entity which is described as Perilymphatic Hypertension.   

  I cannot go further as I cannot  give management advice on this format. 

  If your doctor needs any input, please let me know.  Doctor Fred


   
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Thane
(@mactavish83)
Active Member
Joined: 3 years ago
Posts: 6
Topic starter  

Thanks for the info @dr-joellehrer, I'll talk to my doctor about it as well. I've got an MRV coming up this week to rule out venous sinus thrombosis/stenosis (unlikely, but good to rule out just in case).

It's strange to me that I've spoken to several doctors now and almost none of them will even acknowledge the possibility that internal jugular vein compression from bad head/neck posture could cause elevated CSF pressure (even intermittently), which could in turn affect the vestibular system. They won't acknowledge the possibility of either link: a link between head/neck posture and elevated CSF pressure; and the other link between elevated CSF pressure and vestibular system distortion/dysfunction. I'm really grateful though that my ENT specialist is willing to entertain this possibility and ordered the MRV for me.

I am also working on losing weight. My BMI, right now, puts me into the "overweight" category apparently (but not "obese"), and my understanding of elevated CSF pressure is that being overweight puts me at higher risk of this.


   
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(@bmamikoggmail-com)
New Member
Joined: 11 months ago
Posts: 1
 

Dr Fred

just having increased intracranial pressure and being reflected into the inner ear does not cause dizziness, vertigo or pulsatile tinnitus.

Mammals intracranial pressure goes up when we walk, run, sneeze or cough. We don’t lose hearing or become dizzy.

We only become dizzy or sick when perilymphatic- CSF filtration system cannot compensate this pressure sinusoidal movements.

In many IIH patients the symptoms are headache and papiledema. Yet These IIH does not always develops into symptomatic dizziness or hearing loss but they may have ear pain. 

Pulsatile tinnitus is a sign of dural sinus pathology.

Many idiopathic CSF hypertension cases just like original questioner asks have Subtle MRI findings.

In all suspected cases LP opening pressure must be measured. 

for more information look into my editorial at Otology Neurotology paper and paper at Laryngoscope 

 

 


   
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(@akenealy)
Active Member
Joined: 11 months ago
Posts: 7
 

@mactavish83 I’m a bit late to this thread, but found it very interesting. In 1985, my C-2 vertebra was fractured (car accident) and I wore a halo for 5 months. I know this has affected my posture, cervical curve, etc and have wondered if it’s contributed to my vestibular disorder. 

How are you doing these days? Did you get anymore answers about the pressure? 


   
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(@frankbkelly)
Active Member
Joined: 1 year ago
Posts: 10
 

https://pronorthmedical.ca/"}{"1":600 }">The C1 vertebra also has a problem for me, which was discovered by the X-rays my chiropractor requested. Since then, I've been receiving subluxation therapy and twice-weekly adjustments. My headaches have stopped since starting the therapy, but I'm also hoping that my dizziness will get better. Even when I was sitting down, the waves of vertigo were incapacitating. My symptoms are back, and there has been no diagnosis to date. I have an appointment with a chiropractor next week because they seemed to help the most. I was taking 40mg of Prozac that I had acquired from an online medical supplier in addition to 300mg each day. She advises me to try taking 200 mg daily rather than 300 to see if that lessens my symptoms. For some reason, taking the over-the-counter medication Vanquish, which contains aspirin, tylenol, and caffeine, makes me feel better for a while. I don't drive or travel right now unless I absolutely have to. My use of a cane appears to improve my balance.


   
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(@alexandra)
New Member
Joined: 2 years ago
Posts: 1
 

Any one else on this site have SSCDS?  


   
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(@dannypharmd)
New Member
Joined: 2 years ago
Posts: 3
 

@mactavish83 How have you been ?  Any new updates ?  I may have jugular outlet issues too.


   
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(@bellavolf)
Active Member
Joined: 9 months ago
Posts: 9
 

Cerebrospinal fluid (CSF) pressure can influence vestibular dysfunction in certain conditions, such as idiopathic intracranial hypertension (IIH). IIH is a condition characterized by increased pressure within the skull, which can cause a range of symptoms, including headaches, vision problems, and tinnitus. Vestibular dysfunction, such as dizziness, vertigo, and imbalance, can also occur as a result of increased CSF pressure in IIH.

In IIH, the increased CSF pressure can affect the function of the vestibular system, which is responsible for balance and spatial orientation. The exact mechanisms by which this occurs are not fully understood, but it is believed that the increased pressure may affect the fluid balance within the inner ear, leading to dysfunction of the vestibular hair cells.

In addition, increased CSF pressure can also cause compression of the vestibular nerve, which can lead to vestibular dysfunction. In some cases, surgical interventions such as CSF shunting may be necessary to reduce CSF pressure and improve vestibular function in patients with IIH.

It is important to note that vestibular dysfunction can have multiple causes, and increased CSF pressure is just one of the many factors that can contribute to its development. If you are experiencing symptoms of vestibular dysfunction, it is important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.


   
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(@adelledare)
New Member
Joined: 2 months ago
Posts: 1
 

I am facing some issues, can I ask question here?


   
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 Hope
(@stenu)
New Member
Joined: 2 months ago
Posts: 2
 

@mactavish83 You must be doing well, I hope.

Maintaining a healthy BMI is crucial, and it makes sense to take precautions against any potential risks. Continue your efforts, and I wish you healthful results from your mix of research and dietary modifications.


   
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