Mid Illinois, Springfield / Decatur

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My MRI Is Clean, Why Is My Brain Still Broken?

  November 08, 2018

Submitted by Frederick Schurger, DC, Upper Cervical Springfield

An all-too-common story we hear in our office is, “I’ve gone from doctor to doctor, to therapist to doctor, I’ve tried physical therapy, occupational therapy, chiropractic, I’ve had dozens of tests run — including blood work, MRIs, CAT scans, and x-rays — and everything says I’m normal! But, the brain fog is still there, I have these massive headaches, and my life is falling apart!” These people have been searching for an answer for months, sometimes years, before they walk into my office. What’s worse is the number of providers who end up telling the patient the symptoms are all in their heads, discouraging them so much that they often give up hope of finding relief. The source of the problem is often easier to determine if one just looks in the right area.

Looking in the wrong area
For better or worse, MRI machines cost a lot of money. As such, hospitals and imaging centers have to be economical with their time so that they can get the imaging they need while also keeping on schedule for the next appointment. If you’ve ever been in an MRI, you know it can be strenuous, as you have to hold really still for 20 to 30 minutes at a time.

So, to prevent fatigue and be mindful of the time constraints, many of the MRIs that I see have large gaps between their slices (each individual picture) that may miss some very small structures. For most MRIs, that’s ok because they’re looking for big problems like disc bulges, tumors, and other soft tissue anomalies that may be causing pain. For the patient described above, they latch on to the explanation that they have been diagnosed with a degenerative disc issue in their lower neck (or even lower back), which may not be the biggest issue involved in their discomfort. What if the problem isn’t a disc issue? What if the problem isn’t well visualized on these standard, traditional images?

There tend to be two types of MR imaging that patients bring me for their problems: head and neck. You would think that these two sets of images overlap to some degree; after all, the head is attached to the neck in most of us! But, something got lost along the way between the two scans — many head scans only cover to the bottom of the skull, and many neck scans only cover to the top of disc at the second segment of your neck (the axis). This means the first segment in your neck, the atlas, which has no disc above or below it, is often overlooked in many of these scans. The first two segments in your neck have more neurological input into the brain than any other area of your spine, and as such, can have a huge influence on how your body is working. This area is one of the few areas in the body that has a near-direct impact on your vagus nerve — which I’ve discussed in previous articles — and your body’s ability to heal (the parasympathetic nervous system). If that wasn’t enough, this area also is an important thoroughfare for fluids making their way into and out of the brain!

A novel look at the head and neck
In this often-overlooked area of the neck, there are a lot of stabilizers that “house and protect the spinal cord, multiple cranial nerves, and many important blood and lymphatic vessels that supply the head and neck. This craniocervical junction must protect its contents while simultaneously allowing significant mobility.” This area of the spine is a little like your ankle; in the same way that it’s easy to sprain an ankle because it’s just held in place by muscles and ligaments. The problem is, we often don’t feel the pain of these ligaments immediately when an injury happens. Or worse, we have head or neck trauma that leads to a concussion, which can happen from 60 to160G of applied force.

A mild strain of the cervical spine happens at only 4.5 G. Even the most mild of concussions will likely have some level of cervical spine injury. Patients with cervical spine injury and concussion were four times more likely to have persistent symptoms than those with concussion and neck injury.

There are also three different fluids that move in and out of the brain: arterial blood, venous blood, and cerebral spinal fluid. These three fluids maintain a delicate balance in the brain by keeping it nourished and buoyant (your brain floats in your head). If there’s any disruption to the flow, even a small one, it can cause some significant problems.

Scott Rosa, DC and Michael Freeman, MD have been clinically researching cerebral spinal fluid flow with the engineers at FONAR MRI for over 10 years, and they find that there are a significant number of people who have decreased cerebral-spinal fluid flow that goes undiagnosed in most conventional MRI machines. The reason is simple. The machine that Dr. Rosa uses scans while the patient sits upright in gravity. Most MRI’s have us laying down on our back. Upright MRI research in trauma patients have shown a 50-percent increase of the presence of a Chiari malformation1, a condition where the brain (cerebellar tonsils) is lower in the skull than it is supposed to be. This Chiari malformation can restrict proper CSF flow in and around your brain, and may be related to proper glymphatic drainage of the brain.

Drs. Rosa and Damadian (inventor of the MRI) have found that even the smallest Chiari presentation reduced CSF flow around the brain.

Even subclinical Chiari presentations (less than 5mm of change in the brain’s resting place) have been shown to disrupt CSF flow around the brain. Looking at the brain in gravity often shows the problem more clearly. After all, we tend to spend more time sitting and standing than laying down.  

How we fix it
Working with imaging centers here in Central IL, many have started to include additional imaging to include the upper neck area, allowing some overlap in those scans. This lets us see this area better, and better images lead to quicker diagnosis of symptoms and a more direct path to treatment. We are sharing this exciting information with our local radiologists more and more so that they can better find these potential issues, be it potential obstructions in CSF flow or torn ligaments that may be leading to the craniocervical junction being less than stable. Patients who present to our office get a full evaluation and imaging to determine neurostructural shifts of the segments of their neck. This allows us to create custom corrections so that we can adequately move them back to their normal position and allow stabilization — which often results in relief of secondary conditions/symptoms.

This collaboration among local healthcare professionals means the long suffering of so many people may be shortened, often dramatically by getting a neurostructural evaluation and correction of their upper neck. Recognizing that there’s a problem before it becomes a major clinical issue saves everyone time and money.

As an engineer, Dr. Schurger looks at the whole body as system to determine what is best for each patient. Custom spinal imaging is performed for each patient in order to create a precise, custom correction for each and every patient. Dr. Schurger is one of 20 Diplomates in Chiropractic Craniocervical Junction Procedures (DCCJP), making him uniquely qualified to help those with these kinds of neck traumas. His practice, Upper Cervical Springfield, is at 450 S. Durkin Drive, Ste. B, Springfield. Call 217-698-7900 to set up a complementary consultation to see if he can help you with a neurostructural shift in your spine.

Sources available upon request.

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November 08, 2018

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