Zeureka wrote: drsclafani wrote: Nunzio wrote:
This is a picture from my MRV with a view from the top.
The top of the image shows my left sinus and the bottom shows the right one which is considerably smaller.
Bring it on nunzio
dilate the jugulars and then see if flow improves in the sinuses
Thanks Nunzio for those pics! Wish I could get some like that from my head...but I hope, lets see the follow-up they can provide me in Belgium.
Dr Sclafani, understand that at this moment only thing that can be done in case of sinus thrombosis or stenosis is angioplasty of the jugulars and hope that this has impact. Correct?
zeurika, this not what i meant to convey and, I guess this is a difficult concept to get your hands around.
1. i think (and hope) that most patients have increased resistance to flow in the dural sinuses because of low obstructions and that this causes an appearance
of stenosis or occlusion rather than a real stenosis or occlusion. If you treat the lower obstructions, I hope that this increases blood flow through the sinuses that looks occluded.
2. some patients have a dominant
flow through one dural sinus, while the other one is small. This could be congenital or it could be acquired after a prior thrombosis. A narrow bony canal where the sinus exits the skull will always cause dominance of the other side.
3. Dural sinus thrombosis can be caused by many things. DST has not been associated with MS very often, except in case reports. The usual causes are pregnancy or contraceptive medications, dehydration, inflammatory bowel disease, kidney failure, drug induced, or patients who are prone to clotting. IT can be seen after trauma, brain surgery, venous catheterizations, strokes, cancers (probably by making patients hypercoagulable, or trauma.
How long would you think relieving a thrombosis in the sinus could take after jugular intervention? Could such a thrombosis be resolved in some weeks/months or to count at least a year? And in case of a stenosis in the sinus can widening of the jugulars really have impact?
i am not saying that opening up stenosis of the jugular vein will do much to reverse a thrombosis of the dural sinus. That might require angioplasty or stenting or both, in addition to thrombolysis with clot busting drugs
I am just asking since have a friend with RR that has stent in left jugular since two months now and still no impact on the "limbo" (dizziness, how he calls it). But his situation seems stabilised for now (in terms of no relapse since stopping Tysabri, and before without Tysabri had 5 per year). Since it is his major disabling symptom already non-stop since 9 years(!), could this be an indication that the sinuses most likely stenosed?
I am not saying that. Some patients just do not respond to dilatation. Moreover it usually takes two veins being diseased to have ccsvi. which is the other one?
>>And stenosis of jugular veins is reported to be associated with dural sinus thrombosis, leading to mental confusion and memory problems, loss of balance, and fatigue that resolves after the thrombus is dissolved and the jugular stenosis is angioplastied.<<
reported in case reports so far.
When such a thrombosis dissolves could this be associated to pain (strong strange headaches) over a longer period - such as I had for 10 days?! Started with shorter migraine after 2 days and then longer heavy headaches 5 days after procedure and were finally(uff!) after 1 month completely gone. Am now also 3 months after procedure headache-free.
not sure that those headaches represent. Could be increased venous flow, or could be due to the angioplasty, or could be a small relapse?