CSF pressure influence on vestibular dysfunction
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?
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
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.
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?
@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.
@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
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.