CCSVI or MS

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http://en.wikipedia.org/wiki/Chronic_cerebro-spinal_venous_insufficiency

Diagnosis

Doppler sonography showing venous reflux

CCSVI has been first found in the CNS of several persons using extracranial and

transcranial doppler sonography[3]. The normal method for performing

sonographies has to be adapted to the special reflux that is expected[4]

In cases of stenosis, it can also be diagnosed via MRV (magnetic resonance

venography) and SWI (Susceptibility weighted imaging), but the operator has to

know what to look for. Computed tomography is less precise but the results are

more operator-independent.

Venograms are the gold standard proof of abnormalities but they are X-ray based

and are performed only after previous tests have shown something wrong. Blocks

in the azygous vein can be indirectly and non-invasively detected only by the

means of Doppler sonography, and, invasively by selective venography. 1 Azygous

obstruction occurs approximately in 90% patients affected by CCSVI associated to

MS, and in the totality of patients affected by the primary progressive course.

Impedance phlebography is currently under study for diagnosis.

[edit] Symptoms and consequences

The known consequences of the disease are hypoxia, delayed perfusion[5], reduced

drainage of the catabolites and increased transmural pressure,[6] and iron

deposits around the cerebral veins[7][8][9], with unknown final effects for the

health of the patients.

A connection with Multiple Sclerosis has been proposed (all cases of CCSVI were

found in MS patients[3]) but the possible relationship is still under study.

[edit] Treatment

Venous valves prevent reverse blood flow.

The disease, when it is due to stenosis, can be treated currently in two ways: A

method called " Liberation procedure " , consisting in balloons to open the veins,

in the hope they will remain open[10], and venous stents, to keep them open

permanently. It is unknown if chemical vasodilation can improve this condition,

but seems unlikely in cases of stenosis due to mechanical pressure.

When it is due to defective venous valves, a possibility of repair them called

valvuloplasty exist, but has never been performed for CCSVI. It is currently

unknown whether blood thinners or artificial blood can help in this condition.

Being a physical flow problem, the possibility of practising good posture and

working ergonomically could reduce the consequences of reflux. In the case of

blocked jugulars, the condition could be improved by standing as much as

possible, sleeping inclined or sitting up, in order to avoid using the

jugulars[4], but again no studies exist to date.

Also part of the damage caused by CCSVI (iron accumulation) could be reduced.

There are some substances called iron chelators able to remove the iron in the

tissues. They are present in natural substances as green tea. Also antioxidants

could help to reduce the damage. Endothelial disrupters (saturated fats[11],

cigarette smoking[12], heavy metals, excessive alcohol, toxins, EBV, etc) are

dangerous in this condition.

[edit] Venous MS hypothesis

CCSVI presence has been used to diagnosize MS in a blind experiment with high

sensitivity and specificity for MS diagnosis[3]. A larger trial is ongoing at

Buffalo Neuroimaging Analysis Center[13]

All known cases of CCSVI have been found in MS patients. All tested patients

showed CCSVI (they were previously selected excluding non-standard MS such as

Balo or Schilder, but including progressive variants). None of the controls

showed it. Therefore is expected that CCSVI is present at least in a subset of

MS patients and this has led to hypothesize the existence of a MS subtype of

venous origin.

A number of histopathologic studies, independent from CCSVI research team, had

provided previous evidence of vascular problems[14], or that hemodynamic

abnormalities precede sub-cortical gray matter changes in multiple

sclerosis[15]. There is therefore evidence that MS could involve a hemodynamic

disorder[16], confirmed by seven-tesla MRI[17].

Special tissues (Normal appearing brain tissues, NAWM, NAGM) have been found in

MS, in which lesions are expected to appear[18][19]. They show a primary

vascular injury[20]

Further, it has been shown that:

• Iron depositions appear in deep gray matter by magnetic field correlation

MRI[21] and by transcranial sonography[22]

• NAWM shows a decreased perfusion which does not appear to be secondary to

axonal loss[23]

• Other vascular problems unrelated with CCSVI produce MS-like lesions[24]

Given that the expected sympthoms of CCSVI (hypoxia, delayed perfusion and iron

accumulation) are present in MS, causality has been proposed. This hypothetic MS

subtype of venous origin is named " venous MS " .

As of 2009, no proof exists that to cure CCSVI will cure MS.

[edit] History

Reilly

koala5@...

http://www.linkedin.com/in/amandareilly

http://www.flickr.com/photos/minkoala

http//canadaMS