I .. did not believe there are structures .. that we are not aware of
June 2, 2015 5:54 PM   Subscribe

"In a stunning discovery that overturns decades of textbook teaching, researchers at the University of Virginia School of Medicine have determined that the brain is directly connected to the immune system by vessels previously thought not to exist." While the article at Sciencedaily.com may be a bit breathlessly excited about it, even the more somber source article in Nature agrees that this "may call for a reassessment of basic assumptions in neuroimmunology"
posted by rmd1023 (95 comments total) 122 users marked this as a favorite
 
I read this earlier and really hoped to listen while smart people to talk about it. This is so not my area of biology, but it really does boggle my mind that with all the cadavers and all the brain surgery we could have somehow missed it.
posted by hydropsyche at 6:02 PM on June 2, 2015 [8 favorites]


An excellent comment from the thread on Hacker News:

tl;dr lymphatic nodes go all the way up the back of your brain and into your sinuses. We'd been ripping them out and throwing them away every time we did autopsies or dissections because they were attached to the inside of the skull. Oops.
posted by Amplify at 6:03 PM on June 2, 2015 [41 favorites]


I can't decide whether this makes me more or less nervous about my upcoming medical school anatomy class this fall.
posted by ocherdraco at 6:04 PM on June 2, 2015 [4 favorites]


"...There has never been a lymphatic system for the central nervous system, and it was very clear from that first singular observation -- and they've done many studies since then to bolster the finding -- that it will fundamentally change the way people look at the central nervous system's relationship with the immune system."

Even Kipnis was skeptical initially. "I really did not believe there are structures in the body that we are not aware of. I thought the body was mapped," he said. "I thought that these discoveries ended somewhere around the middle of the last century. But apparently they have not."
Between this, the recent discovery that gut bacteria regulate serotonin uptake, and a last year's discovery of a link between serotonin synthesis, vitamin D and autism, I'm optimistic that we're on the verge of a series of major breakthroughs in the diagnosis and treatment of mental illness.
posted by mhoye at 6:08 PM on June 2, 2015 [72 favorites]


WHOA!!! This is big. Very big.
posted by Deoridhe at 6:12 PM on June 2, 2015 [3 favorites]


I do not know what to think of this. I need to go find a neuroscientist.
posted by maryr at 6:15 PM on June 2, 2015 [1 favorite]


Does that vitamin D thing work for depression also? That's low serotonin right?


This is all amazing.
posted by sio42 at 6:21 PM on June 2, 2015 [1 favorite]


Going to have to meditate on this a bit.
posted by b1tr0t at 6:22 PM on June 2, 2015 [2 favorites]


I wasn't sure what to think of it either. I saw a link to the sciencedaily article on Twitter and then spent a while checking out whether it was a real science site or not, and then followed the journal reference link to Nature. And then made very sure that it was actually Nature and not, like, some fake nature-looking site. And even so, I was half expecting the post to get shut down because it was some hoax site at the root of it.
posted by rmd1023 at 6:22 PM on June 2, 2015 [5 favorites]


The glymphatic system was first officially described in 2012. That's a whole system that cleans YOUR BRAIN and no one ever knew to even name it until 3 years ago. Crazy.
posted by SkinnerSan at 6:28 PM on June 2, 2015 [5 favorites]


As another med student: super cool. Super, super, super cool.

Lymphatics are analogous to a sewer system in your body, collecting runoff and sending the fluid through checkpoints to clean out contamination before putting it back into circulation. Much like sewers, they are slightly mysterious and often underappreciated.

Like the Hacker News link says, we've known for a long time that some sort of bidirectional link exists between the brain and the immune system, but it was supposed to be more along the lines of chemical messaging. Nobody was really thinking to find anything on the order of an actual lymph system. I checked my physiology textbook just to be sure, and the phrasing used is indeed that cerebral interstitial fluid and protein drain into the subarachnoid space and from there to the CSF "because no true lymphatics are present in the brain."

Never stop learning, folks, cause the world doesn't stop either.
posted by saturday_morning at 6:35 PM on June 2, 2015 [33 favorites]


The glymphatic system was first officially described in 2012.

ok srsly you can't just stick a letter in front of a body system and say you discovered a whole new one
posted by threeants at 6:35 PM on June 2, 2015 [85 favorites]


y'all should check out the snervous system, it helps your kidneys disperse uh hormonal fluids through uh I give up
posted by threeants at 6:36 PM on June 2, 2015 [81 favorites]


And yes "glymphatic" just sounds like someone swallowed at the wrong time whilst talking
posted by saturday_morning at 6:37 PM on June 2, 2015 [7 favorites]


Of course there is a connection; how do you think meningitis happens?
posted by Renoroc at 6:47 PM on June 2, 2015 [1 favorite]


Once upon a time I had an awesome rheumatologist who treated me like a person with a brain and whom I loved. I was very sad when I moved and she couldn't be my doctor anymore. Anyway, she told me that the thing I had to understand about the immune system was that nobody really understood why it went wrong sometimes, because nobody really understood how it worked in the first place. She said it was like medicine's final frontier, and sometime they would crack the mystery of how it worked, and when that happened there would be all sorts of great new treatments for autoimmune diseases. So does this mean that that's starting to happen? Because that would be kind of amazing.
posted by ArbitraryAndCapricious at 6:48 PM on June 2, 2015 [25 favorites]


Well the point of giving the glymphatic its own name was we hadn't figured out how it was connected to the lymphatic system and thought it might be its own thing, right?

This is so cool thanks for posting this rmd1023!
posted by Wretch729 at 6:48 PM on June 2, 2015


Cut to the chase doc

Is this going to unlock our latent telekinetic powers or what
posted by prize bull octorok at 6:48 PM on June 2, 2015 [38 favorites]


Even Kipnis was skeptical initially. "I really did not believe there are structures in the body that we are not aware of. I thought the body was mapped," he said. "I thought that these discoveries ended somewhere around the middle of the last century. But apparently they have not."

Didn't they just figure out that the clitoris is actually gigantic and mostly internal like... 10 years ago?
posted by showbiz_liz at 6:52 PM on June 2, 2015 [28 favorites]


The immune system is such an astonishing set of mechanisms that the discoveries are going to keep coming for a while. Every so often I go back and read up what I can (primary material is well beyond me, so this is a bit hit and miss), and each time there's some new complex reaction to pathogens or a new signalling system between classes of cells or a bizarre yet compelling description of intricate behaviour. And the knowledge works, too - see the announcement a couple of days ago that a combination of drugs modifies the immune system so that it can recognise and attack melanomas.

That there's a macroscopic physical structure we missed? It probably won't be the last. It was only around 2000 that we discovered a whole new photoreceptor system in the eye, entirely independent of the rods and cones we knew about.
posted by Devonian at 6:53 PM on June 2, 2015 [9 favorites]


Of course there is a connection; how do you think meningitis happens?

Renoroc: generally it's understood that it happens either by hematogenous spread (bacteria in the bloodstream, while not virulent enough to cause sepsis, seed the meninges and colonize them) or contiguous spread (direct invasion of bacteria through the soft tissues of the head after a sinus or throat infection). I've also heard of neural spread (backwards propagation of microbes along the cranial nerves into the brain) but I believe that's more for viral meningitis and fairly rare.
posted by saturday_morning at 6:58 PM on June 2, 2015 [2 favorites]


Didn't they just figure out that the clitoris is actually gigantic and mostly internal like... 10 years ago?

2009, I guess?
posted by maryr at 7:08 PM on June 2, 2015 [1 favorite]


I'm always ready to believe there are a whole lot of subtle things we don't know about the body - the exact way [tab A] protein fits into [slot A] receptor and that kind of thing, because those are the kinds of discoveries that keep getting discovered. But every once in a while there would be a story about some non-microscopic discovery (like the one about all the things we didn't know about the human clitoris until 2009!). This is in that category: wow wow wow. Wow.

On preview: slow type jinx!
posted by rtha at 7:08 PM on June 2, 2015 [2 favorites]


"The vessels were detected after Louveau developed a method to mount a mouse's meninges"

...

mount a mouse's meninges

mount a mouse's meninges

Well call me a monkey's uncle and mount a mouse's meninges, Bertha!
posted by showbiz_liz at 7:10 PM on June 2, 2015 [47 favorites]


y'all should check out the snervous system

snervous (snail nervous)
posted by poffin boffin at 7:10 PM on June 2, 2015 [11 favorites]


The clitoris discovery actually goes back as far as 2005, so 20 years at least.
posted by Proofs and Refutations at 7:29 PM on June 2, 2015 [1 favorite]


The clitoris discovery actually goes back as far as 2005, so 20 years at least.

Er...


*checks watch
posted by saturday_morning at 7:30 PM on June 2, 2015 [58 favorites]


So would this have implications for immune system diseases (like Crohn's or ulcerative colitis) or just neurological ones?
posted by waitingtoderail at 7:33 PM on June 2, 2015


Eyes, clitoris, brain. Is there some global research project into porn processing we haven't been told about?

("We choose to do these things not because they are easy, but because they are harder, oh, harder, harder baby, harder...")
posted by Devonian at 7:42 PM on June 2, 2015 [16 favorites]


saturday_morning: "The clitoris discovery actually goes back as far as 2005, so 20 years at least.

Er...


*checks watch
"

Dude. It's Metafilter. Tell me the first transtemporal post would NOT happen here.
posted by Samizdata at 7:49 PM on June 2, 2015 [23 favorites]


I'm optimistic that we're on the verge of a series of major breakthroughs in the diagnosis and treatment of mental illness.

Long-term, I wonder if there might be environmental law implications of this breakthrough...? For example, if dirty air causes a person's immune system to respond, how might that affect mental illness? What if downwind of a coal plant or factory we can prove an increase not just in respiratory illness but also mental illness? How will that affect public policy?

That's just one aspect. This is really exciting and made me come up with a hundred questions, and I'm looking forward to knowledgeable people discussing this, because I'm pondering this knowing little about how the immune system works. . . but apparently I'm not the only one, haha!
posted by barchan at 7:52 PM on June 2, 2015 [8 favorites]


So typically when there's a big discovery like this, how long does it take before actual human beings start getting cured of stuff?
posted by If only I had a penguin... at 7:55 PM on June 2, 2015


a new signalling system between classes of cells or a bizarre yet compelling description of intricate behaviour

i was just reading about DNA methylation in epigenetic memory :P "For example, in one recent experiment, mice that were given a shock after smelling a certain chemical learned to fear this smell... and this trait was passed down to their children and grandchildren — apparently by means of DNA methylation!"
posted by kliuless at 7:56 PM on June 2, 2015 [8 favorites]


Speaking as someone with MS, colour me excited for future research.

It will be interesting to see this new part of the lymphatic system in relation to the blood-brain barrier.
posted by mephisjo at 7:57 PM on June 2, 2015 [9 favorites]


Tell me the first transtemporal post would NOT happen here.

Well, that's why I checked my watch, one must never assume
posted by saturday_morning at 7:58 PM on June 2, 2015 [4 favorites]


What if downwind of a coal plant or factory we can prove an increase not just in respiratory illness but also mental illness?

As someone who grew up in the rust belt, this would not surprise me in the slightest.
posted by selfmedicating at 8:00 PM on June 2, 2015 [4 favorites]


"This luminous network inside the doll. It could be anything. It could exist inside us, though we haven't discovered it yet. When we find the right stain-" He shrugged.

Lewis Padgett, "Mimsy Were the Borogoves"
posted by shii at 8:05 PM on June 2, 2015 [5 favorites]


Reminds me of when, in 1996, we discovered a new facial muscle. Apparently by dissecting a corpse in a new way.
posted by kalessin at 8:05 PM on June 2, 2015 [3 favorites]


i was just reading about DNA methylation in epigenetic memory :P "For example, in one recent experiment, mice that were given a shock after smelling a certain chemical learned to fear this smell... and this trait was passed down to their children and grandchildren — apparently by means of DNA methylation!"

LAMARCK WAS RIGHT

IN A HIGHLY QUALIFIED MANNER
posted by clockzero at 8:06 PM on June 2, 2015 [28 favorites]


See, Sir Terry was right! All the best laboratory assistants are Igors:

"Kipnis also saluted the "phenomenal" surgical skills of Igor Smirnov, a research associate in the Kipnis lab whose work was critical to the imaging success of the study"
posted by Blueeyed at 8:08 PM on June 2, 2015 [41 favorites]


I bet these scientist guys, when they were young and didn't have any proper toys, they were always thinking about lymph, and doing little puppet shows for the family about lymph, and their mothers were like: "You and your lymph. You've got lymph on the brain!" And that planted the seed of curiosity, because if you've got lymph on the brain, then how did it get there? Through some kind of lymph spigot? Maybe this old bat is on to something. So in a way their mothers are the real heroes here.
posted by turbid dahlia at 8:36 PM on June 2, 2015 [13 favorites]


So typically when there's a big discovery like this, how long does it take before actual human beings start getting cured of stuff?

How long is a piece of string?
posted by STFUDonnie at 8:37 PM on June 2, 2015 [8 favorites]


Well since I said "start" I would like to know the length of the shortest piece of string. I'm going to say the length of the shortest piece of string depends no the gauge of the string, since if you cut the length shorter than the diameter of the string, it wouldn't be a string. It would be a disc. I am unsure how to apply this analogy to the question, though. Maybe at least as long as it took to do this study? How long was that?
posted by If only I had a penguin... at 8:43 PM on June 2, 2015 [3 favorites]


I'm having trouble finding any data on the world's longest string, but it must by definition be shorter than the world's largest manmade object or structure, which is the Great Wall of China. So shorter than 13,171 miles. This is pointless I'm sorry.
posted by showbiz_liz at 8:50 PM on June 2, 2015 [7 favorites]


Cool! And it was just in 2013 that a new knee ligament was first identified and characterized, which may have significance for improving knee surgery outcomes. It's exciting to think that there's still neat stuff to discover about our anatomy!
posted by darkstar at 8:50 PM on June 2, 2015 [5 favorites]


Still waiting on the X gene.
posted by Halloween Jack at 8:51 PM on June 2, 2015 [2 favorites]


I really wish they stressed this more in school. I somehow went years and years as a kid thinking it was pointless to go into science because we basically already knew everything except for the fine details.
posted by showbiz_liz at 8:52 PM on June 2, 2015 [11 favorites]


Sorry if I was curt, I just meant to illustrate that "how long" questions are often unanswerable. I think for the sake of those who suffer from potentially relevant medical issues that it would be reckless to guess.
posted by STFUDonnie at 9:01 PM on June 2, 2015 [1 favorite]


Watch the tonsils and adenoids be a vital part of this system. We were yanking them out assembly-line style in the 80s, though I gather they're not as gung-ho about that today.
posted by fifteen schnitzengruben is my limit at 9:04 PM on June 2, 2015 [5 favorites]


"The first time these guys showed me the basic result, I just said one sentence: 'They'll have to change the textbooks.' "

As a scientific illustrator, all I have to say is: PROFIT!
posted by Kabanos at 9:05 PM on June 2, 2015 [24 favorites]


CranialSacral therapy practitioners and satisfied patients maybe enjoying a 'told you so' style moment around about now.
posted by Thella at 9:05 PM on June 2, 2015 [3 favorites]


Could this be a route to deliver drugs past the blood - brain barrier?
posted by Rumple at 9:20 PM on June 2, 2015


Could this be a route to deliver drugs past the blood - brain barrier?

Whoever heard of someone consuming drugs through their nose. The very idea is comical.
posted by Pyry at 9:26 PM on June 2, 2015 [27 favorites]


It's surprising how many major diseases are autoimmune results -- Diabetes and MS comes to mind, and both appear significantly treatable by nuking and rebooting the immune system.

Unfortunately that particular treatment has something like a 1% mortality rate.
posted by effugas at 9:35 PM on June 2, 2015


Through some kind of lymph spigot?

Incidentally, "Lymph Spigot" is the name of my new grunge band. We do Spinal Tap covers.
posted by Greg_Ace at 9:35 PM on June 2, 2015 [41 favorites]


My husband has psoriatic arthritis, and on his initial consult with his rheumatologist, the doctor said "I'm starting to believe that these diseases aren't a dysfunction of the immune system -- rather, they're the immune system responding appropriately to haywire signals it's getting from from some other system. We've deduced the existence of that system, but we haven't identified it."
posted by KathrynT at 9:41 PM on June 2, 2015 [16 favorites]


I know this is going on the list of research I'll be discussing with my rheumatologist at my next visit.
posted by immlass at 9:51 PM on June 2, 2015


Thella: "CranialSacral therapy practitioners and satisfied patients maybe enjoying a 'told you so' style moment around about now."

The light touches in CST haven't a hope of influencing these extremely tightly bound lymphatic ducts. It's the equivalent of saying that if I touch your car on the roof, oil will leak out below.

People don't like the idea of organically separated neurohumoral systems interacting through loosely coupled biochemical waves. It doesn't seem intuitive, and the time-signalling issues are troublesome. Saying that there's a more direct "pipe" will get the point of integrated organ systems across easier. A more direct link between brain and gut will make it easier to explain to patients how some depressions and IBS sub-types can be different expressions of the same pathology. Also, a lot of the recent work on schizophrenia sub-types and cytokines makes more sense.
posted by meehawl at 10:02 PM on June 2, 2015 [18 favorites]


Now I have to wonder about the comorbidity of asthma and autism -- is this some kind of vitamin D deficiency coupled with inflammation?
posted by wuwei at 10:04 PM on June 2, 2015


Thella: "CranialSacral therapy practitioners and satisfied patients maybe enjoying a 'told you so' style moment around about now"

No. Don't. Don't take this exciting new discovery to somehow confirm quackery just because it sounds like it might be related. Craniosacral therapy claims to somehow cure disease by somehow moving cerebrospinal fluid around by somehow just lightly touching the outside of a person's head, and this somehow synchronizes the brainwaves of the quack and their unlucky victim. That's impossible in at least three different ways not related to this discovery at all.
posted by Joakim Ziegler at 10:31 PM on June 2, 2015 [30 favorites]


It's the equivalent of saying that if I touch your car on the roof, oil will leak out below.

Ohhhhh, so it's you who's been messing with my car! You hoodlum. (rooflum?)
posted by Greg_Ace at 10:48 PM on June 2, 2015 [1 favorite]


Dude. It's Metafilter. Tell me the first transtemporal post would NOT happen here.

It is Metafilter, so the first transtemporal post wioll haven't on-happened without a Douglas Adams reference.
posted by Jon Mitchell at 11:04 PM on June 2, 2015 [8 favorites]


I don't know how these cats got in the time machine or why
posted by Ghostride The Whip at 11:19 PM on June 2, 2015 [8 favorites]


The implications for Bipolar Disorder and its psycho-physiological relation are staggering.
posted by aloiv2 at 11:26 PM on June 2, 2015 [1 favorite]


Could this be a route to deliver drugs past the blood - brain barrier?

If I'm understanding the summaries correctly it could be a new option. But designing drugs (especially oral drugs) to get into the lymph system has its own set of challenges, not necessarily less than designing drugs that get past the BBB.
posted by mark k at 11:26 PM on June 2, 2015


on his initial consult with his rheumatologist, the doctor said "I'm starting to believe that these diseases aren't a dysfunction of the immune system -- rather, they're the immune system responding appropriately to haywire signals it's getting from from some other system. We've deduced the existence of that system, but we haven't identified it."

That's an interesting way of putting it.

One candidate for the "other system" that's giving the immune system "haywire signals" would seem to be the collective human microbiome.

In the case of scarlet fever, which damaged my mother's heart when she was a child, a particular strain of strep infects the throat and the immune system attacks it, but in an instance of a phenomenon we now call "molecular mimicry", the strep presents antigens to the immune system which are similar enough to antigens in the joints that the immune system attacks those joints as well, and then goes on to attack the heart muscles.

Presumably this benefits the strep bacteria by causing the immune system to lessen the intensity of its attack, which allows the infection to last longer or even become chronic, which in turn increases the chances it will be passed on.

One form of psoriasis (guttate psoriasis) appears to be caused by strep, but I didn't see any information about the likelihood of developing arthritis from guttate psoriasis.
posted by jamjam at 11:31 PM on June 2, 2015 [3 favorites]


If only I had a penguin...: So typically when there's a big discovery like this, how long does it take before actual human beings start getting cured of stuff?

For some idea of the average time from target identification (i.e. what do you want your drug to do) to market have a look at the graphic the bottom of this page: http://www.thepmcf.ca/Our-Impact/Clinical-Research-Care/How-Does-a-New-Drug-Get-to-Market

Also a nice graphic at the bottom of this page: http://www.ott.emory.edu/inventors/process.html showing out of 10 000 initial drug candidates average time for a single drug to survive past all stages including final FDA review. In both cases not sure what data set(s) they're drawing on but sites look legit.

Being as you say, a big discovery, this could speed things up or slow things down - that's the length of string bit ;) But the nice thing about science is that we can generally come up with some measure of an average for something (obviously it's the distribution which you really care about but then it gets increasingly messy)
posted by Beware of the leopard at 12:26 AM on June 3, 2015


Because I'm bored and haven't really played around with Google sheets yet or metafilter's comment abilities*

Time to market:

From the Princess Margaret Cancer Foundation** Link
 Min  | Max  | Avg. | Period
  1   |  3   | 1.5  | Drug discovery + Pre-clinical
  2   |  10  |  5   | Clinical trials
 0.17 |  7   |  2   | Government approval
Total mean 8.5 years

From Emory University**
 Min  | Max  | Avg. | Period
  1   |  3   | 1.5  | Drug discovery
  1   |  3   | 1.5  | Pre-clincal
  2   |  6   | 3    | Clincal trials
  1   |  3   | 1.5  | FDA review
Total mean 7.5 years

* Man. Formatting tables in a metafilter comment is an exercise in pain. Does anyone have any pointers?

PMCF - Canadian; Emory University, US
posted by Beware of the leopard at 3:09 AM on June 3, 2015 [4 favorites]


Louveau had better clear a space on his shelf for this.
posted by rory at 3:13 AM on June 3, 2015 [1 favorite]


meehawl - The light touches in CST haven't a hope of influencing these extremely tightly bound lymphatic ducts.

Here is an anecdote about one of my friends whose teenage daughter was riding a bicycle along a canal towpath when she hit her head on an overhanging tree branch. She was a bit dazed immediately afterwards, but no visible damage other than a bump on the forehead. Over the next two minutes her eyesight faded away to nothing and she became blind. Accident and emergency did some scans and concluded they could do nothing to help.
The child was booked in to see a cranial osteopath after a terrifying week of blindness and walked out of the treatment room with her sight fully recovered. This may just be coincidence.
posted by asok at 3:26 AM on June 3, 2015 [1 favorite]


saturday_morning: "The clitoris discovery actually goes back as far as 2005, so 20 years at least."

Welcome to the bodybuilding.com science forums!
posted by grumpybear69 at 4:45 AM on June 3, 2015 [11 favorites]


So typically when there's a big discovery like this, how long does it take before actual human beings start getting cured of stuff?

The JAK2 V627F mutation plays a role in myleoprolifetative disorders and was discovered in 2005. Since then, it's been used as part of the diagnostic criteria for MPNs and has lead to a number of drugs which effect gene expression. A paper was published in the past month that claims complete molecular remission. So it can move fast, given the right circumstances.
posted by [insert clever name here] at 4:58 AM on June 3, 2015 [1 favorite]


saturday_morning: The clitoris discovery actually goes back as far as 2005

Man did Philip Larkin have bad luck. Born too late and didn't live to see 2005.
posted by Beware of the leopard at 5:08 AM on June 3, 2015


When I saw the phrase "the brain is directly connected to the immune system," I immediately thought "now there's a mechanism to explain the placebo effect."
posted by CheeseDigestsAll at 5:36 AM on June 3, 2015 [4 favorites]


Here is an anecdote about one of my friends whose teenage daughter was riding a bicycle along a canal towpath when she hit her head on an overhanging tree branch. She was a bit dazed immediately afterwards, but no visible damage other than a bump on the forehead. Over the next two minutes her eyesight faded away to nothing and she became blind. Accident and emergency did some scans and concluded they could do nothing to help.
The child was booked in to see a cranial osteopath after a terrifying week of blindness and walked out of the treatment room with her sight fully recovered. This may just be coincidence
.


This is an unbelievable anecdote. First A&E would never decide there was nothing to be done. They are emergency care. They would refer to a neurological specialist once a patient is safe from immediate danger. I don't believe even the worst British hospital would say "Oh wells yuz blind get out" and leave a patient for the quacks.

This smells like bullshit of the dangerous sort. Why are you doing this?
posted by srboisvert at 5:45 AM on June 3, 2015 [16 favorites]


Wonder if this discovery will lead to a rethinking of the removal of tonsils and tonsillitus?
posted by spock at 5:46 AM on June 3, 2015


This is an unbelievable anecdote. First A&E would never decide there was nothing to be done. They are emergency care. They would refer to a neurological specialist once a patient is safe from immediate danger. I don't believe even the worst British hospital would say "Oh wells yuz blind get out" and leave a patient for the quacks.

This smells like bullshit of the dangerous sort. Why are you doing this?


To head off any potential GRAR I'd chalk this up to a friend of a friend situation mixed with telephone. First off bump to forehead leading to "eyesight faded away to nothing and she became blind" extremely unlikely (unless triggers stroke but that just raises other questions). Serious blow to back of the head (visual cortex etc.) , then yeah, anything goes.

Most likely tree branch actually contacts eye region - swelling etc. Possibility of permanent injury to eye ruled out by A&E. CAT, possible MRI as precaution A&E rightly say nothing to be done till swelling goes down after which eyesight returns. Involvement of cranial osteopath "may just be coincidence".
posted by Beware of the leopard at 6:21 AM on June 3, 2015 [6 favorites]


tl;dr lymphatic nodes go all the way up the back of your brain and into your sinuses. We'd been ripping them out and throwing them away every time we did autopsies or dissections because they were attached to the inside of the skull. Oops.

So, uh, are there any other parts that just get thrown away or ignored during autopsies that we might want to take a look at? Perhaps?

“Yeah, this weird flap that we always ignored turns out to be our cancer-fighting gland, whoops”

“This translucent goo we always thought was just messy is the thing that prevents obesity”

“Can you believe that all this time the cure for HIV/AIDS was right there in that lung nodule no one ever studied? Go figure!”
posted by a fiendish thingy at 7:15 AM on June 3, 2015 [4 favorites]


Paging Dr. Zoidberg. Autopsy in room 214.
posted by sneebler at 7:23 AM on June 3, 2015 [1 favorite]


Props to science! I love that scientists are willing to accept new evidence and change their minds in light of facts. This should not be a rare quality relegated to one corner of culture, though.

I will be following this with avid interest, as a person who identifies as neuro-atypical but hard to diagnose.
posted by Beethoven's Sith at 7:56 AM on June 3, 2015 [1 favorite]


One candidate for the "other system" that's giving the immune system "haywire signals" would seem to be the collective human microbiome.

Yeah, I have been starting to have prickly gestalt-feelings about the gut microbiome being heavily involved in autoimmune diseases. The problem with that hypothesis of course is that it's very, very difficult to test; gut bacteria is species-specific, highly individualized, and almost entirely unculturable, so good studies on it require vast populations and expensive investigation techniques. Which means lots and lots of time and money. And meanwhile, in the absence of solid science, eighty billion kinds of woo proliferate, it's very frustrating.
posted by KathrynT at 8:01 AM on June 3, 2015 [2 favorites]


A friend has had IBS for years and it doesn't respond well to much, so he's constantly seeing new specialists and trying new regimes. I'm amazed by how hard it is to get much diagnostic material from the gut biome; his latest test was checking for hydrogen levels (!) and that was quite a palaver. (I didn't realised that E. coli produces hydrogen as part of its basic metabolism, and through a remarkable mechanism.)

If you're looking for complex interactions, the huge number of non-human organisms in our bodies and our immune system must be constantly engaged in the most intricate of exchanges. If ever there was a target for building a nano-lab you could swallow... it's all very well creating glorious Mars rovers that can sample rocks in a hundred ways, and long may that continue, but I'd like to see some more Fantastic Voyage stuff.
posted by Devonian at 8:17 AM on June 3, 2015


See also: the appendix as key storage location of good gut bacteria. Not another extraneous organ.
posted by gingerbeer at 8:27 AM on June 3, 2015 [1 favorite]


his latest test was checking for hydrogen levels (!) and that was quite a palaver.

Hey, hydrogen breath tests are a real thing! that's how my kid was diagnosed with her IBS-like disorder.
posted by KathrynT at 9:00 AM on June 3, 2015


When I saw the phrase "the brain is directly connected to the immune system," I immediately thought "now there's a mechanism to explain the placebo effect."

What mechanism do you mean?
posted by clockzero at 9:29 AM on June 3, 2015


So a few years back there was some news regarding blood vessels in fibromyalgia patients. Though it seems it's related to the hands from what I recall.

I'm a little confused - they say that this system runs next to the circulatory system, right. The connection is actually vessels, not the actually the lymphatic system itself?

I wonder if there's a relationship between the hand vessels news and this.?
posted by symbioid at 9:34 AM on June 3, 2015


From the article:

These structures express all of the molecular hallmarks of lymphatic endothelial cells, are able to carry both fluid and immune cells from the cerebrospinal fluid, and are connected to the deep cervical lymph nodes.

So yes, they are lymphatic vesseles, connected to nodes.
posted by grumpybear69 at 9:42 AM on June 3, 2015 [1 favorite]


Yeah, I have been starting to have prickly gestalt-feelings about the gut microbiome being heavily involved in autoimmune diseases. The problem with that hypothesis of course is that it's very, very difficult to test; gut bacteria is species-specific, highly individualized, and almost entirely unculturable, so good studies on it require vast populations and expensive investigation techniques. Which means lots and lots of time and money. And meanwhile, in the absence of solid science, eighty billion kinds of woo proliferate, it's very frustrating.

We need a Human Microbiome Project.
posted by showbiz_liz at 10:29 AM on June 3, 2015 [10 favorites]


"CranialSacral therapy practitioners and satisfied patients maybe enjoying a 'told you so' style moment around about now"

It's just as likely to justify phrenology.
posted by maryr at 11:20 AM on June 3, 2015 [7 favorites]


asok: "booked in to see a cranial osteopath after a terrifying week of blindness and walked out of the treatment room with her sight fully recovered."

Without an optho or neuro workup to locate a temporary, inflammatory lesion (either within the organ, along the optic tracts or within the occipital or parietal lobes), when something like this unexpectedly presents, and then just as unexpectedly remits, it's highly likely to be a trauma-induced conversion symptom.
posted by meehawl at 1:13 PM on June 3, 2015 [4 favorites]


Here is an anecdote about one of my friends whose teenage daughter was riding a bicycle along a canal towpath when she hit her head on an overhanging tree branch. She was a bit dazed immediately afterwards, but no visible damage other than a bump on the forehead. Over the next two minutes her eyesight faded away to nothing and she became blind. Accident and emergency did some scans and concluded they could do nothing to help.
The child was booked in to see a cranial osteopath after a terrifying week of blindness and walked out of the treatment room with her sight fully recovered. This may just be coincidence.



This is an unbelievable anecdote. First A&E would never decide there was nothing to be done. They are emergency care. They would refer to a neurological specialist once a patient is safe from immediate danger. I don't believe even the worst British hospital would say "Oh wells yuz blind get out" and leave a patient for the quacks.

This smells like bullshit of the dangerous sort. Why are you doing this?
My partner accuses me of being able to take any wild story or the most dubious of factoids, jack it up, and then slide a superficially plausible explanation under it. There's more justice to this complaint than I like to admit.

That stipulated, I think this particular anecdote does hang together in an interesting way.

First, there is a class of head injuries which, when surgically corrected even after surprisingly long intervals, has occasionally shown dramatic and apparently miraculous restoration of function: depressed skull fractures. This has been known for many years and has often caught popular imagination; in the fifth volume of the Anne of Green Gables series, Anne's House of Dreams, for example, astonishingly beautiful Leslie Moore is trapped in a loveless marriage to a sailor which was a ghastly mistake from the beginning, made yet worse by his return from the far East with a depressed skull fracture which has obliterated his memory and rendered him less able to do for himself than a small child, thereby sentencing Leslie to a miserable and wasted life as his round the clock caretaker. Suddenly a new surgical procedure offers a hope of restoring his memory, and Leslie must choose whether to allow it, haunted by the prospect that success could lead to his reassertion of his marital rights, which she would find utterly insufferable, and which horrifies Anne and her husband (and the reader).

Our skulls are made up of separate plates which evolved from vertebrae and are held together by sutures that resemble stream meanders writ extremely small, yet until the age of forty or so most people's sutures are not completely welded, and permit some movement of the plates with respect to each other, especially vertically, or rotationally with the suture acting as a kind of hinge.

I see it as entirely possible that a blow to this girl's forehead could have pushed the forehead plate down with respect to contiguous plates and caused it to get stuck in a slightly depressed state -- where it might then act just like a depressed skull fracture. Craniosacral manipulation, which purports to restore the plates in the skull to their proper relationship just as chiropracty supposedly does the vertebrae of the spine, popping them back into position by moving them along their joints, would then function in her case like surgery would in a case of a depressed skull fracture.

Blindness rather than an effect localized to a part of the brain under the forehead I would explain by reference to migraine headaches, which whatever part of the brain they originate in, typically produce fortification illusions by causing the visual cortex to press up against the skull, suggesting that the visual cortex has a tendency to press against the skull when the brain swells (or the skull shrinks), and by the fact that blindness is such a dramatic symptom people might not have looked for or noticed anything else.

As for A & E leaving "a patient for the quacks", remember that this was a young girl. If emergency didn't find an organic cause on physical examination backed up by scans, they'd likely call it conversion disorder (aka hysterical blindness).
posted by jamjam at 3:20 PM on June 3, 2015


Eh, I've had noticeable improvements to my eyesight (like the room suddenly seeming much brighter) after osteopathic adjustments to my upper neck too. So I buy that there's some sort of connection there, although not necessarily as dramatic as in asok's anecdote.
posted by Jacqueline at 3:38 PM on June 3, 2015


Jacqueline: "Eh, I've had noticeable improvements to my eyesight (like the room suddenly seeming much brighter) after osteopathic adjustments to my upper neck too. So I buy that there's some sort of connection there, although not necessarily as dramatic as in asok's anecdote."

This sounds mostly like a pleasure response after having your neck and scalp massaged, to be honest. I've personally had this kind of experience of sensory change after things like massages, orgasms, a deep kiss, or the onset of certain drugs. Serotonin rush, maybe?
posted by Joakim Ziegler at 3:58 PM on June 3, 2015 [2 favorites]


jamjam: "I see it as entirely possible that a blow to this girl's forehead could have pushed the forehead plate down with respect to contiguous plates and caused it to get stuck in a slightly depressed state -- where it might then act just like a depressed skull fracture. Craniosacral manipulation, which purports to restore the plates in the skull to their proper relationship just as chiropracty supposedly does the vertebrae of the spine, popping them back into position by moving them along their joints, would then function in her case like surgery would in a case of a depressed skull fracture."

I doubt this would not be noticeable on a CAT scan, and I doubt even more that the slight pressure used in craniosacral manipulation would be able to fix a depressed skull fracture (especially since it's pressure, which probably won't be able to pull a depressed plate outwards).

It sounds much more likely that it's either a result of swelling which then went down, or a conversion symptom.
posted by Joakim Ziegler at 4:03 PM on June 3, 2015 [1 favorite]


I know it's not directly about mental health, but this kind of story reminds me with amazement and relief that one day the medical response to mental health problems (and so many other currently-mysterious health problems) will be better than: "We don't quite know what's going on, but let's just try these powerful drugs and see what happens."

Thank you, scientists.
posted by penguin pie at 5:16 AM on June 15, 2015


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