New Discovery Uncovers Possible Link Between Dementia and Underlying Condition

As per the research published in Science Daily, Wouter Schievink, MD, head of the Cerebrospinal Fluid Leak and Microvascular Neurosurgery Program and professor of Neurosurgery at Cedars-Sinai mentioned that many of these patients have severe cognitive, behavioral, and personality problems that require them to be arrested or placed in nursing homes.

“There is no therapy for patients with behavioral-variant frontotemporal dementia of unknown origin. Our findings, on the other hand, suggest that people with cerebrospinal fluid leaks can be treated if the source of the leak is identified and addressed.  

By circulating in and around the brain and spinal cord, cerebrospinal fluid (CSF) shields them from injury. When this fluid enters the body, it can cause the brain to sag and induce dementia. According to Schievink, many people with brain sagging (which may be detected with an MRI) go untreated.

Thus, he recommends clinicians reevaluate their treatment approaches for patients who exhibit specific symptoms. Schievink suggested that the MRI be reviewed by a “knowledgeable radiologist, neurosurgeon, or neurologist” to look for signs of brain drooping.  

Clinicians should also ask whether the patient has a history of severe headaches that only go away while lying down if they have extreme daytime drowsiness despite receiving enough sleep at night, and if they have ever been diagnosed with Chiari brain malformation (a condition in which brain tissue extends into the spinal canal). Schievink discovered that brain sagging is sometimes misdiagnosed as a Chiari malformation.  

When brain drooping is identified, determining the cause of a CSF leak may be challenging. Fluid seeping from a rupture or cyst in the surrounding membrane can be identified with CT myelogram imaging with contrast media.  

Schievink and colleagues discovered a new channel for CSF leakage: the CSF-venous fistula. After entering a vein, the fluid becomes more challenging to detect with a standard CT myelogram. Technicians must utilize a specific CT scan to detect these breaks and follow the contrast medium as it moves through the CSF.  

This imaging method was used on 21 people with head drooping and bvFTD symptoms in this investigation, and CSF-venous fistulas were discovered in nine of them. When the fistulas in all nine individuals were medically corrected, the drooping in their brains and other symptoms went away.  

According to Keith L. Black, MD, chair of the department of Neurosurgery and the Ruth and Lawrence Harvey Chair in Neuroscience at Cedars-Sinai, imaging advances have significantly boosted the capacity to detect sources of CSF leak, particularly CSF-venous fistula. Because “this specialist imaging is not frequently available,” the study’s findings highlight the need for more excellent research into improving patient diagnosis and treatment rates.  

Since leaks in their brains could not be found, all 12 study participants with sagging brains were treated with non-targeted therapy, such as implanted devices for infusing the patient with CSF. However, just three of these participants reported an improvement in their health. 

As per the research published in Science Daily, Wouter Schievink, MD, head of the Cerebrospinal Fluid Leak and Microvascular Neurosurgery Program and professor of Neurosurgery at Cedars-Sinai mentioned that many of these patients have severe cognitive, behavioral, and personality problems that require them to be arrested or placed in nursing homes.

“There is no therapy for patients with behavioral-variant frontotemporal dementia of unknown origin. Our findings, on the other hand, suggest that people with cerebrospinal fluid leaks can be treated if the source of the leak is identified and addressed.  

By circulating in and around the brain and spinal cord, cerebrospinal fluid (CSF) shields them from injury. When this fluid enters the body, it can cause the brain to sag and induce dementia. According to Schievink, many people with brain sagging (which may be detected with an MRI) go untreated.

Thus, he recommends clinicians reevaluate their treatment approaches for patients who exhibit specific symptoms. Schievink suggested that the MRI be reviewed by a “knowledgeable radiologist, neurosurgeon, or neurologist” to look for signs of brain drooping.  

Clinicians should also ask whether the patient has a history of severe headaches that only go away while lying down if they have extreme daytime drowsiness despite receiving enough sleep at night, and if they have ever been diagnosed with Chiari brain malformation (a condition in which brain tissue extends into the spinal canal). Schievink discovered that brain sagging is sometimes misdiagnosed as a Chiari malformation.  

When brain drooping is identified, determining the cause of a CSF leak may be challenging. Fluid seeping from a rupture or cyst in the surrounding membrane can be identified with CT myelogram imaging with contrast media.  

Schievink and colleagues discovered a new channel for CSF leakage: the CSF-venous fistula. After entering a vein, the fluid becomes more challenging to detect with a standard CT myelogram. Technicians must utilize a specific CT scan to detect these breaks and follow the contrast medium as it moves through the CSF.  

This imaging method was used on 21 people with head drooping and bvFTD symptoms in this investigation, and CSF-venous fistulas were discovered in nine of them. When the fistulas in all nine individuals were medically corrected, the drooping in their brains and other symptoms went away.  

According to Keith L. Black, MD, chair of the department of Neurosurgery and the Ruth and Lawrence Harvey Chair in Neuroscience at Cedars-Sinai, imaging advances have significantly boosted the capacity to detect sources of CSF leak, particularly CSF-venous fistula. Because “this specialist imaging is not frequently available,” the study’s findings highlight the need for more excellent research into improving patient diagnosis and treatment rates.  

Since leaks in their brains could not be found, all 12 study participants with sagging brains were treated with non-targeted therapy, such as implanted devices for infusing the patient with CSF. However, just three of these participants reported an improvement in their health.