This Is MS Multiple Sclerosis Community: Knowledge & Support

LET ME TRY TO INTERPRET THIS INTO ENGLISH FOR YOU. MY TRANSLATION WILL FOLLOW PART OF THE REPORT IN ALLCAPS


REPORT


SUPINE STUDY:

Right IJV Cross-sectional area: 17.5mm^2
Left IJV Cross-sectional area: 30.5mm^2

IN THE LYING DOWN POSITION, THE LAB HAS MEASURED THE AREA OF THE CIRCUMFERENCE OF THE JUGULAR VEIN. AS YOU CAN SEE THE AREA OF THE LEFT IS ALMOST TWICE THAT OF THE RIGHT. HOWEVER COMPARISON OF RIGHT AND LEFT DO NOT HAVE SIGNIFICANCE. COMPARISON OF LYING DOWN AND SITTING UP IS IMPORTANT.

Prominent echogenic bands in the J1 segment of the left IJV
ECHOGENIC BANDS ARE SOUND REFLECTIONS OF TISSUE, IT COULD BE BANDS, ABNORMAL VALVES, SEPTATIONS, ETC THIS IS A B-MODE ABNORMALITY


Intermittent retrograde flow in the J2 segment of the left IJV
PERIODIC FLOW BACK UP TOWARD THE HEAD IN THE MIDDLE OF THE JUGULAR VEIN. THIS IS ABNORMAL. WE CALL IT REFLUX.

Normal antegrade flow in the right IJV, vertebral, and deep cerebral veins.
BUT THAT REVERSED FLOW ONLY OCCURS IN THE LEFT INTERNAL JUGULAR VEIN. THE OTHER MEASURED VEINS HAVE FLOW IN THE CORRECT DIRECTION. THIS ZAMBONI CRITERIA IS MET WHEN ANY OF THE VEINS FLOW BACKWARD. YOU DO NOT HAVE TO HAVE IT IN MORE THAN ONE OF THE VEINS.



UPRIGHT STUDY: USUALLY DONE SITTING UP, NOT STANDING.

Right IJV Cross-sectional area: 21.4mm^2 (change from supine= -3.9mm^2

THE CROSS SECTIONAL AREA DIFFERENCE BETWEEN UPRIGHT AND LYING DOWN ON THE RIGHT (ALSO KNOWN AS DELTA CSA). WHEN YOU SUBTRACT THE UPRIGHT FROM THE SUPINE AND GET A NEGATIVE NUMBER, THAT MEANS THAT THE CSA IS LARGER UPRIGHT THAN SUPINE. NORMALLY THE VEIN GETS SMALLER WHEN YOU ARE UPRIGHT BECAUSE THE FLOW NORMALLY GOES THROUGH THE VERTEBRAL VEIN WHEN SITTING AND STANDING.

Left IJV Cross-sectional area: 4.8mm^2(change from supine= +25.7mm^2
THIS IS WHAT IS NORMALLY SUPPOSED TO HAPPEN. THE VEIN IS BIGGER SUPINE THAN UPRIGHT.

Normal antegrade flow in the IJV and vertebral veins

ANTEGRADE FLOW MEANS THAT THE FLOW IN THE VEIN IS BACK TO THE HEART. tHIS IS THE DIRECTION VENOUS BLOOD IS SUPPOSED TO GO.

Retrograde flow in the deep cerebral veins
THE FLOW IN THE DEEP CEREBRAL VEINS IS GOING BACK TOWARD THE HEAD. THIS IS NOT WHAT IS SUPPOSED TO HAPPEN;. THIS IS ABNORMAL. THIS IS THE PART OF THE TEST THAT IS DONE WITH THE PROBE AGAINST THE TEMPLE OR NEAR THE EAR. IT IS CALLED TRANSCRANIAL DOPPLER.


INTERPRETATION:

1. Criteria for CCSVI 4/5 (qualifying factor for CCSVI is 2/5)
THE FIVE CRITERIA ARE
1. REVERSAL OF FLOW IN AN IJV OR VERTEBRAL VEIN (YOU HAVE THIS)
2. REVERSAL OF FLOW IN THE DEEP CEREBRAL VEINS (YOU HAVE THIS)
3. ABSENCE OF FLOW FOR PART OF THE VASCULAR CYCLE(YOU DO NOT HAVE THIS)
4. A NEGATIVE DELTA OF CSA (YOU HAVE THIS)
5. B-MODE ABNORMALITIES LIKE STENOSES, THICK VALVES, (YOU HAVE THIS)

I hope this helps[/b]

Long time reader, first time writer No words would describe how thankful I am for all this informations...

Had the procedure done in Albany last August. A real success, my life has changed. 3 months in a couple of days, that's a long placebo effect

I'm from Canada. Cannot get the doppler under Dr.Z protocol done locally. Was lucky enough to have a local IR to perform a regular doppler. Was I right to think that it might not be the best follow-up scenario, but if there's something major (like a thrombosis), he would catch it?

Very kind man, felt reassure when I met him. He also suggested to avoid stents if possible and prefers multiple angioplasty. Can't wait not having to pay for it everytime though!! He was pleased to tell me my angioplasty had been nicely done

Dr. S it appears that people with functioning valves in the blood return flow to the heart don't have symptoms that have been associated with MS.
It appears that people without non return valves to the brain accumulate symptoms associated with MS (over long periods of time).
It appears the body has found ways to return blood flow to the heart called collaterals which appear to overcome back pressure as the persons blood pressure is not raised.
Is it possible that the issue for PwMS is simply that the blood is not restricted from back flow to the brain. If there were working valves to stop the blood flowing back to the brain the malformations would not need to be angioed?
If surgeons have been able to replace heart valves is it possible that replacing or installing valves will be the resolution of back flow/reflux issues for PwMS.
Regards Nigel

Dr. Scalfani,

Thank you so much for the clarification...covered everything perfectly and I was even able to help my aunt decifer her report. Can't thank you enough for all of your support!

Would it be possible for these issues to cause chest pains/pains in left arm. I have been having these intermittently for years, sometimes to the point where I feel like I am having a heart attack, but all tests on my heart have come back normal...just wondering if the poor blood flow would be causing any of this?

And one more question...sorry...you had mentioned about the transcranial doppler...I have always had headaches but lately I have been getting stronger ones that run from my left jaw up behind my left eye...I am good for at least 2 or 3 a day...again just wondering if the retrograde flow could be the cause of these headaches?

Once again, thanks for all of your help...you are a savior for those of us who can't find anyone to give us any answers or support.

Dr, Joan Beal has been posting about blood testing lately can you talk to us about what we need to be aware of when choosing a treatment provider and what we need to be having done for the follow up period/time?
Thanks Nigel.

Quote;http://www.facebook.com/notes/ccsvi-in-multiple-sclerosis/please-read/454425162210
Patients who have angioplasty need a very specific blood thinning regimen tailored to them, and this needs to be followed by a doctor who can test INR and PT (coagulation numbers) Many people have angioplasty and have no idea they have hypercoagulation before being treated....this is a terrible problem.

Dear Dr. Sclafani,


I was one of those patients that developed numbness of the fingertips of both hands immediately following the procedure. These symptoms developed and persisted despite clear improvements with my gait following balloon angioplasty of my azygous. The numb fingers were a completely new symptom for me. I had spent lots of time wondering why this happened and would like to propose what I think is a explanation.

With balloon angioplasty of a major obstruction in one of the venous outflow routes from the CNS, the obstruction is relieved on that side and there is more flow down that once obstructed vein. This increased flow on the ballooned side must somehow be compensated for by decreased blood flow on the other the other side (or other outflow route). I think this can be supported by hemodynamic principals. It is this decreased flow on the other side that I believe may cause these new or aggravated symptoms. I suspect this type of problem is made worse if there is residual or unrecognized stenosis on the "unaffected side". This was my situation. I had my azygous opened up but ballooning of the 100% occlusion of my brachiocephalic vein was not even attempted and left as it was.

North

It is my impression that the IJV blockages are the low hanging fruit of ccsvi treatment. Dr Sclafani, can you comment more on the azygos issue and its diagnosis, treatment and implications. I have heard some claim that azygos issues are more common in those with lower body mobility problems.

Are patterns being identified correlating blockages/disrupted flow with any symptoms. Maybe ijv with fatigue or mental fog? azygos? what about sigmoid sinus? Is there a connection with any blockages and lower extremities swelling--many experience feet or ankles swelling? It could be a totally unrelated issue.

I do not think that pain in your arm and chest would result from the venous problem, except if the ccsvi caused multiple sclerosis pain symptoms that radiated into your arm or if ccsvi caused multiple headaches.

I do not think that reflux up the jugular vein is really the pathophysiology of this entity. Dr. Zamboni suggests that it the obstruction that is the real problem. This leading to reversal of flow through small vessels not designed to take that kind of flow. I do not think the problem is pressure or reverse pressure. it is flow