TRANSKRYPCJA VIDEO
Dr Jeffrey Hannah
Brain Fog, Dizziness, and Neck Compression: What Research Shows
Opis wygenerowany przez Skrybot
The speaker explains how spinal canal narrowing (e.g., disc bulges/stenosis) can restrict cerebrospinal fluid (CSF) flow, potentially causing pressure fluctuations that may contribute to symptoms like brain fog and pain/pressure behind the eyes—even when MRI results appear “normal.” They reference an in-vitro study finding that mild–moderate stenosis minimally affects CSF dynamics, but severe narrowing can significantly reduce CSF “dynamic compliance” and increase pressure spikes. The talk also highlights that real-life conditions include the spinal cord’s presence, which the model didn’t fully simulate. Finally, it discusses “cerebellar crowding” (including Chiari-related issues) as another space-occupying factor that may reduce the room CSF needs to circulate, affecting balance and neurologic function. The speaker argues for conservative, mechanical/structural approaches first (physical therapy, upper cervical chiropractic, possibly craniosacral therapy) and suggests that restoring CSF flow may improve quality of life, sometimes without obvious large structural abnormalities on imaging.
Transkrypcja wygenerowana przez Skrybot
That fluid is basically accumulating inside of the head. It might seem relatively normal on an MRI, but the processes of what's going on on the inside is that there is this constant bit of pressure. And again, what are people oftentimes going to say? I've got brain fog. I've got pain behind my eyes. I've got pressure on the inside. It just. . . Here we go. Hello everybody. I am Dr. Jeffrey Hanna. I am a board certified upper cervical chiropractor and welcome to Cervical Genesis, the show where we're talking about how your neck can relate to a lot of health issues including headaches, complex pain syndromes, and also balance disorders.
And in today's episode what we're going to be looking at is fluid pressure inside of the spine but also how it relates to the head. Oftentimes people can experience what they describe for lack of a better description as persistent brain fog or pressure behind my eyes or blurry vision or just I can't quite think straight. Lots of MRIs, lots of tests can be done and nobody can exactly figure out what's going on because there's no overt pathology that we can see on that. But emerging research goes into a condition that it's very, very tricky to diagnose. But the fancy term is a idiopathic normal pressure hydrocephalus.
In hydrocephalus, in brief, what this would mean is it means that not necessarily bleeding in the brain, but the circulation of the fluid on the inside, something is causing an increase of that pressure on the surface. Looks relatively normal, but beneath the surface there can be a few contributing factors. So what I want to do here in this video is share with you some research that's come out, but then relate this back to a few findings that oftentimes show up on an MRI that you can have a look at that may explain, well, why is it that radiologists, medical doctors, specialists saying everything looks normal, but that there can still actually be some much bigger issues coming from what are relatively small things. So here's what we've got for you.
Dynamic compliance of the cerebral spinal fluid CSF system in idiopathic normal pressure hydrocephalus. This is part one. And in vitro, so this isn't a live, this is a lab investigation of the impact of spinal canal stenosis. In brief, what a stenosis is, this means a narrowing. So you're going to have brain, you're going to have the spinal canal and then the vertebra, all that sort of stuff. Well, in the middle of the vertebra is the opening, which is the conduit for your spinal cord. And the spinal cord itself is not just slapping around willy-nilly on the inside. It's bathed by what's known as the cerebral spinal fluid.
It's contained within a container of basically connective tissue that's going to help anchor it to the spine, but also is going to provide a certain degree of protection and also flexibility so that as you're moving around, it's not going to be producing any issues or problems there. The kicker then is if you've got something going on in your body that is causing that to become narrower. The biggest one that people are probably familiar with would be the idea of a bulged or a herniated disc. Because if the disc, so the little shock absorber between the vertebra starts to bulge into the back area, well that can start to produce an obstruction and as a result that space is going to start to get narrower.
If it becomes really really compressed, it can actually start to physically distort the spinal cord itself. That is going to lead to a host of different issues. pain in the area, numbness and tingling in the fingers and the legs, weakness in being able to stand, balance issues. But also, it can lead to basically where the nerve starts to die. This is a medical emergency. Now, usually your people are experiencing pain long before they start to get to that point, but oftentimes it is dismissed. Now, it's not meaning, okay, it's dismissed because it's not important, but it means that, again, these little things, perhaps are not taken into full consideration the way that they should be.
Nevertheless, what these researchers are looking at is they recognize that, okay, this narrowness or the stenosis, oftentimes it's age-related, not because of a person's chronological age, but usually the result of old physical injuries where your body has basically been accumulating little bits of corrosion or wear and tear on the inside. Body is brilliant in its ability to adapt to stress, but ultimately it can only do so much before, dude, we can't do this anymore. Muscles are going to try to absorb it. If they fail, it's going to go into the joints and into the ligaments. Discs are ligaments. If that fails, it starts to affect neurovascular structures. So what these particular researchers did, in fact, let me flip it over here.
They did what I think was a pretty nifty little simulation here. So here's the full article here, and I'll give you the link. It's open access, so you can read through this if you want. But in brief, what they did was they set up a system that was going to mimic the normal circulation of this cerebrospinal fluid on the inside. And what they did then was used a simulated little device here, essentially representing where you start to produce this mechanical constriction or this stenosis, this narrowing, and what they wanted to see was how the fluid would actually change its circulation on the inside. So let's jump straight ahead to what their findings were. The results indicate that mild to moderate stenosis have minimal impact on cerebral spinal fluid dynamics.
In other words, little disc bulges which are present in 85% percent of the people don't seem to be causing too many issues but severe stenosis so in the neck or the cervical spine they say less than 33 percent what that actually means in terms of their description here is where that diameter is decreased by 66 percent two-thirds of it are basically compressed or narrowed meaning that it's only a third or 33 percent of its original size you and the lumbar spine diminished all the way down to under 20% of its normal size. So you can have pretty big bulges that are not producing any symptoms, but when they cross a certain threshold, that is going to significantly alter the ability of this fluid to circulate.
Now, these alterations were characterized, this is important, and characterized by reduced dynamic compliance, so less flexibility and decreased flu with increased pressure amplitudes up to 7. 85 millimeters of mercury. Okay, cool, but what does that actually mean? Let me put it this way, that when this fluid is circulating on the inside, it's normally going to be oscillating a little bit like this. So it's going to be moving up, it's going to be moving down. And the normal resting pressure of cerebral spinal fluid inside of the head and in the spinal canal itself is 50. 15 millimeters of mercury. In other words, when you start dealing with pretty pronounced stenosis or disc bulges or different things like that, you are going to increase the amount of pressure by 50% of the normal.
And the brain and the spinal cord, these exist within a confined amount of space. So at rest, it might appear as if the pressure is normal, But because of these stenosis, you can have spikes of that amplitude where it's going to then feel like there is this pressure, this pain, this discomfort that's going on on the inside. If it's going to be in the spine, that can produce localized or radiating pain. But even if something is happening in the neck or in the low back, there are going to be upstream effects where if that fluid is basically accumulating inside of the head, it might seem relatively normal on an MRI. But the processes of what's going on on the inside is that there is this constant bit of pressure.
And again, what are people oftentimes going to say? I've got brain fog. I've got pain behind my eyes. I've got pressure on the inside. It just feels like if somebody could release the valve, things would feel an awful lot better. That's what this research is saying is that when you've got these issues of the spine, it can affect the ability of this fluid to circulate. on the inside and it may have the potential to affect not just the back, not just the neck, but also the brain itself. Now, I'm going to elaborate on a couple of things right here, because personally, I'm not the kind of person who just likes reading the summary. Summaries are great. They're awesome. I will use them.
But then if there's an interesting article, okay, hey, I want to dive deeper into this. Because one of the questions that I had about this, okay, because they're using basically the just. . . open tube right there. But in a real life person, you've got the tube with the serenospinal fluid, but you've got the cord itself that is also on the inside. They didn't take that into account. And in fact, they say so right here. So even though they're looking at this kind of, let me scroll down just a little bit there. Again, this idea of kinking a hose or something like that, the hose is vacant. There's nothing on the inside there.
What the researchers were looking at, inclusion of the spinal cord or spinal nerve roots was not required in this model as the influencer movement is not the subject of this work. In other words, as awesome as this work is, it's not complete because in a real human being, you have to consider not just the fluid, but also the occupation of that space because of the spinal cord itself. Now this part then that I'm going to share with you, this is purely hypothetical because what we're doing is we're taking what the findings of this research are, and again I think this is a pretty cool study, but then we have to apply it to a real human being.
What these guys are talking about is again is when you have the inability of the fluid not to move. So not necessarily physical compression of the spinal cord itself. You're talking about if you have stenosis of the fluid or the space around the spinal cord. If that can't circulate, that can increase the pressure even if the nerves are not getting physically pinched or compressed. And this is the important distinction that I want to make because again, oftentimes from the standard medical approach, and it doesn't mean that they are wrong, they are looking for broken bones. bleeding, infections, tumors, or where the nerve is dying because it's being physically compressed. They're looking to see that if you're dealing with a stenosis that something is actually getting smushed.
But oftentimes what they're not looking at is their narrowing of the ability of that fluid to actually flow around the spinal cord itself. These are the kinds of things that we routinely see in our own practice and I'm going to show you a couple of little examples of that.
and how that can manifest and i'm not going to do it like all inclusive i mean truth is if you're looking at mris you should look at them from every single which way and angle but for the sake of these videos here i try to make it as simplified as i possibly can so just to help orient you a little bit so what we have here is an mri so person's face is going to be over here the spinal uh the vertebrae are right here And then I'll draw your attention to the black thing right here. So this would be the medulla, so the brain stem. Spinal cord is this dark thing that comes down all the way like this.
And I will also then draw your attention to the bright white stuff that we see right there, the bright white stuff in this area. This would be the spinal, excuse me, the cerebral spinal fluid itself. So what I'm going to draw your attention to is that if you're in the upper part of the neck right here, You see that the cord in a midline slice, lots of fluid space right here, no problem whatsoever. But as you start to come down to the level of C3, you can see that there is this black thing right here, there's another one there, there's another one there. Those are the bulging discs that we are talking about, and you can see that they are bulging backward into that opening.
Same right here and then there's a little bit less there and then it opens back up so as the discs are bulging in this area, we do see that they're kind of butting up against the cord a little bit, but not to the point where the thing is being physically deformed, maybe a little bit right there. But the bigger issue that I would point out here, simply put, is there's no space for that bright white stuff to flow. This is what the researchers were actually looking at, And they're finding that even if the nerves themselves are not being compressed, if you have narrowing of the fluid space itself, that can increase the local pressure.
And if there is local pressure right through here, do you think that it's possible that you might be having some symptoms or issues? And again, it's not just localized neck pain. The neurology of this area is going to affect shoulder function, feeling in your hands. It's also the conduit for the information coming up. from your legs. It's also sending the information going back down. But also, if you've got a fluid, essentially a choke point right through here, it means that as that fluid should be circulating throughout the entire canal, it can start to pull back and it can start to congest in the head.
And again, this is hypothesized as one of the contributing factors when people are dealing with these weird brain foggy things just not quite working issues right up at the top. So that's what we're talking about, a stenosis when we are dealing with the neck. But then I'm going to throw another one in there here for you. So this is a phenomenon that's known as cerebellar crowding. And I'm going to make a distinction here between what I often talk about and share with on, you know, these videos here about what's called a Chiari malformation. So just to give you a little bit of orientation so that the previous image that I showed you, that was kind of like a midline slice through the neck.
What we're looking at now is a bottom up. view. So the left side's over here, this is the right side. This is at the very base of the skull. And then this would be as if like a front on view. So left side's over here, right side's over here. And I will draw your attention to this cauliflower shaped thing right here. So this is known as your cerebellum. Cerebellum is the balance coordination hub of the brain that's responsible for maintaining balance. So it has to coordinate info from our eyes, our inner ear, our neck, all parts of the body so that we can have fine-tuned normal movement. In many ways, it's also the conductor for higher brain centers.
In other words, if there's a problem with cerebellum, your brain don't work as good as it should be. It kind of sucks up the bandwidth, if you would. Now, ideally, the cerebellum is going to be sitting inside of the skull itself. Now, some people can have what's known as a Chiari. malformation. What this is, this is a type of a cerebellar ectopia. It's where the cerebellum itself starts to bulge basically down outside of the base of the skull into the spinal canal itself. I use the analogy, well, a couple of analogies. One, imagine if you would, you've got a balloon with a piece of string attached to it.
So the balloon is the brain, string is the spinal cord and imagine that the balloon is sitting inside of the skull like this, but now what you're going to do is you're going to take the string from the bottom. You're going to pull on it like that. That balloon is going to start to bulge down into the opening right there, but the kicker is there's not as much space. So I ask, what size shoe do you normally wear, and could you fit into one or even a half of a size smaller? The answer is yeah you probably could but it's going to be tight So same thing when you're dealing with this phenomenon known as cerebellar crowding.
Now, the standard medical definition and diagnostic criteria for a Chiari malformation is where the cerebellum is descending below the base of the skull by a minimum of five millimeters. But many people can still be experiencing these same kinds of issues, even though, as As you might see in this example, I'll kind of draw your attention. The base of the skull is right here. So this is right on the line. It certainly is not going down by five millimeters. But what is arguably more important, it's not the length of the descent, it's the width or the girth of it.
How much of it is actually occupying that normal space where that white fluid, the cerebral spinal fluid, should flow? So if I come over to this cross section right here, so again, base of the skull over here, I will circle this little feature right there for you. So there would be the uppermost part of the spinal cord itself. These darkish things, these are a pair of vertebral arteries. They're supplying blood up to the brain. And you'll see all of this grayish stuff right through here. The grayish stuff is the cerebellum itself. This area should ideally be pure white. because that's where the fluid should be.
So if you have where the cerebellum is starting to come down just a little bit, and it can happen for a lot of reasons. It can happen in part because of skull formation. It can happen because of physical trauma. It can happen for a lot of different reasons. But one way or another is, even though this guy is not going down by five millimeters, it's obstructing the space. And again, what is the research saying? It's not simply a matter of is the spine or the nerves themselves getting squished.
Are you occupying the space where that fluid should flow? Because if you constrict it, whether it's in the low back, in the middle part of the neck because of a disc bulge, or up at the very top, if something is not moving right with the vertebrae in the upper part of the neck, if that fluid's not circulating the right way, you that is going to affect the function of your brain. It can create issues going down. It can create issues going up. And again, if we are looking at this purely from, okay, is there a curing malformation? The honest answer is no, there isn't. But if you consider the functional relationships of what the fluid should be doing ideally at that level, okay, now it would make more sense.
So I would look at this particular person right here. And if this person was not experiencing headaches, if this person was not experiencing balance issues or other weird little bits of neurology, that would be the thing that would actually surprise me the most. So we need to be aware that again, just because there's not the single big things, if you've got something that's affecting the way that that fluid is supposed to circulate on the inside, that disrelationship can start leading to a whole bunch of issues. So that's kind of the first part is identifying what these issues actually are. And again, just because the report says normal doesn't mean that the smaller things are truly necessarily normal. You got to look at the sum of all these little things.
And as a general rule, I point out a few things here because what I've just shown you, these are structural or mechanical obstructions. What that means is it means from a treatment standpoint, it requires a structural or a mechanical solution. In other words, and I'll say this as always, there's a time and a place for medication, for supplements, for all of these different kinds of things. But that's where we're dealing with disruptions of our physiology or where we just need a little bit of pain relief so we can figure out and get the time, like what do we actually have to do? When you're dealing with structural or mechanical issues, it requires a mechanical solution. So this is going to include a few things.
Number one, okay, physical therapy, keeping your body strong. Number two, upper cervical chiropractic, making sure that the neck is moving the way that it is supposed to and adjusting in a safe manner. I would also add craniosacral therapy into this mix to facilitate that cerebral spinal fluid. Now, as a general rule when dealing with these, you want to try conservative options first, because if things are ever severe enough, whether it is with a disc bulge or with a Chiari malformation where, okay, this is like choking the life out of you, surgery may honestly be required. We don't like it, but there are limitations to the things that the human body can actually adapt to. But you want to try the conservative physical options first.
before you would want to have to go down the surgical route. And truth is, all of the best neurologists, neurosurgeons, orthopedists, they, as a general rule, are going to agree with that. Unless, of course, you're seeing that it's like, okay, something's dying. You need to take like immediate surgical action right away. So hopefully, I've been able to, even though longer video right here, explain a little bit more about the processes here. Because again, it can be very frustrating, I know, for people. When you've been to doctors, specialists, you feel like you've had you all the different tests, everybody says that, quote, things look normal.
What we need to do instead then is we need to start looking at these little functional pieces, how they start to add up because again, just because there aren't broken bones, tumors, lesions, or any really, really big things, if the sum of these little things, and again, even a little disruption in that fluid around those very delicate, delicate neural tissues that can have a disproportionate negative effect, but it also means that if you can find that right solution, even if you can't undo all that damage, if you can restore that normal flow, that normal function, that flexibility, even a millimeter or two, that is oftentimes enough where brain essentially says, thank you for that. This isn't perfect, but we can work with this and we can have a much better quality of life.
So you I hope you guys have enjoyed this video all the way through. If you did, please do click that like button. If you are a registered healthcare practitioner, please make sure you click the subscribe so you get access to other little summaries of some of the pertinent research, thoughts, and ideas. And if you've also got that friend, that family, that colleague, that co-worker who you think that, hey, you need to check this information out, please share this video with them. And then you can also direct them to some of the other videos we have on this channel. or on our clinic website, which is clearchirospokane. com, where again, we're dealing with issues of the neck and how that relates to a lot of complex pain issues, headaches, migraines, also balance issues.
Thank you guys again very much for watching. This is Dr. Jeffrey Hanna at Clear Chiropractic. .
S K R Y B O T
Skrybot. 2023, Transkrypcje video z YouTube
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