It is often said that two or more blockages of the main draining pathways of brain and spinal cord are necessary for MS/CCSVI symptoms to emerge.
In case repeated angiographies fail to recognize more than one, would you suggest preventative ballooning of usually affected areas?
Extending this, under what circumstances would you regard only one blockage as sufficient enough?
but which two vessels can be significant?
This case describes a 40 year old man with chief complaints of cognitive dysfunction, severe fatigue, periodic migraine headaches, temperature intolerance, spasticity and urinary frequency.
Doppler and Bmode ultrasound of the neck and transcranial power doppler of the deep cerebral veins revealed two Zamboni criteria for CCSVI.
Venography was performed to assess the cause of the CCSVI.
Right and Left internal jugular venography was performed. While there was questionable minimal narrowing of the left jugular confluens but flow was brisk and no stasis or reflux was visible. The right internal jugular vein looked normal.
Azygos venography showed a thickened valvular area (red arrow), outflow obstruction (green arrow) and reflux in the descending portion of the vein (orange curved arrows)
Angioplasty was performed of the descending azygos vein and the azygos arch. The final image on the right bottom shows reduction in collaterals and better flow.
So how can this be that one outlet obstruction can cause such symptoms?
imaging of the vertebral veins illustrates that an outlet of a second system IS present. Both vertebral veins are incomplete.
So as we explore, we find that the permutations of vascular anomalies are many. While we have simple answers to some of these anomalies and are moving toward refined methods of treatment, for others we remain novice. How to deal with vertebral vein problems is more complex and will await further thought.