DrSclafani answers some questions

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Postby mo_en » Sun Dec 19, 2010 1:56 pm

That was a real mind-appetizer. Consequently, makes the next question inevitable: Is there a risk of such vertebral vein damage after ballooning the jugulars in their lowest part? It is there where the VVs end, isn't it?
User avatar
mo_en
Family Member
 
Posts: 48
Joined: Thu Dec 09, 2010 4:00 pm
Location: Patras, Greece

Advertisement

Postby drsclafani » Sun Dec 19, 2010 2:46 pm

mo_en wrote:That was a real mind-appetizer. Consequently, makes the next question inevitable: Is there a risk of such vertebral vein damage after ballooning the jugulars in their lowest part? It is there where the VVs end, isn't it?


The vertebral veins drain into the subclavian vein and are adjacent to the jugular vein confluens. i doubt that injury would happen tho
User avatar
drsclafani
Family Elder
 
Posts: 3132
Joined: Fri Mar 12, 2010 4:00 pm
Location: Brooklyn, New York

Postby drsclafani » Sun Dec 19, 2010 3:21 pm

Cece wrote:
drsclafani wrote:imaging of the vertebral veins illustrates that an outlet of a second system IS present. Both vertebral veins are incomplete.

Does incomplete mean that it's partial agenesis of the vertebral veins? I would think a valve issue in the verts might eventually be treatable (you mentioned back in June that Dr. Galleotti had tried treating the verts with negligible or mixed results?) but agenesis would be really tricky. But if it takes two obstructions to cause problems, the clearing of one of the obstructions might yet be enough to relieve the problems.

Thanks for sharing these latest images and case study. :) :)

i think that there is poor development of the vertebral veins. they travel adjacent to the vertebral arteries within the bony canal. at around the sixth vertebra of the neck they exit and travel toward the subclavian vein.
the upper part of the vein in this case were just poorly developed.
User avatar
drsclafani
Family Elder
 
Posts: 3132
Joined: Fri Mar 12, 2010 4:00 pm
Location: Brooklyn, New York

Postby NZer1 » Sun Dec 19, 2010 4:08 pm

drsclafani wrote:
Cece wrote:
drsclafani wrote:imaging of the vertebral veins illustrates that an outlet of a second system IS present. Both vertebral veins are incomplete.

Does incomplete mean that it's partial agenesis of the vertebral veins? I would think a valve issue in the verts might eventually be treatable (you mentioned back in June that Dr. Galleotti had tried treating the verts with negligible or mixed results?) but agenesis would be really tricky. But if it takes two obstructions to cause problems, the clearing of one of the obstructions might yet be enough to relieve the problems.

Thanks for sharing these latest images and case study. :) :)

i think that there is poor development of the vertebral veins. they travel adjacent to the vertebral arteries within the bony canal. at around the sixth vertebra of the neck they exit and travel toward the subclavian vein.
the upper part of the vein in this case were just poorly developed.


Hi Dr are these problems in the Verts hard to image or assess?
They have always been of interest to me.
User avatar
NZer1
Family Elder
 
Posts: 1517
Joined: Thu Feb 18, 2010 4:00 pm
Location: Rotorua New Zealand

Re: Follow up CCSVI report..

Postby Cece » Sun Dec 19, 2010 5:00 pm

Nunzio wrote:In the future I envision using external stents to prevent extrinsic compression of the Jugular vein. I know Dr.Noda was releasing the scalene muscle to prevent compression.
The same concept goes for people claiming they have the carotid bulb indenting the Jugular vein.

By external stents, do you mean around the vein from the outside, put in surgically? I don't think it would work by the carotid, because internally or externally, an IJV stent would put pressure on the wall of the carotid, possibly causing slow heart beat or other issues.
Your problem is that Gazelle have a long neck prone to these misalignment problems. If you were an Hippopotamus with a short neck, you might be just fine even though "lady Hippopotamus" doesn't have the same ring as "lady Gazelle"
Good luck on your new treatment.

:) :D
Cece
Family Elder
 
Posts: 9009
Joined: Mon Jan 04, 2010 4:00 pm

Postby drsclafani » Sun Dec 19, 2010 5:05 pm

NZer1 wrote:
drsclafani wrote:
Cece wrote:
drsclafani wrote:imaging of the vertebral veins illustrates that an outlet of a second system IS present. Both vertebral veins are incomplete.

Does incomplete mean that it's partial agenesis of the vertebral veins? I would think a valve issue in the verts might eventually be treatable (you mentioned back in June that Dr. Galleotti had tried treating the verts with negligible or mixed results?) but agenesis would be really tricky. But if it takes two obstructions to cause problems, the clearing of one of the obstructions might yet be enough to relieve the problems.

Thanks for sharing these latest images and case study. :) :)

i think that there is poor development of the vertebral veins. they travel adjacent to the vertebral arteries within the bony canal. at around the sixth vertebra of the neck they exit and travel toward the subclavian vein.
the upper part of the vein in this case were just poorly developed.


Hi Dr are these problems in the Verts hard to image or assess?
They have always been of interest to me.


i do not usually attempt catheterization and venography of the vertebral artery, although it is not uncommon for the catheter to enter this vessel when attempting catheterization of the internal jugular vein.

I perform contrast studies of the VV, in the following circumstances
1. when I cannot catheterize the internal jugular vein, i will inject whatever veins i get into. That venogram sometimes gives clues to where the jugular vein is located.
2. when i find no other signs of ccsvi
3. when only one vessel seems involved by ccsvi
User avatar
drsclafani
Family Elder
 
Posts: 3132
Joined: Fri Mar 12, 2010 4:00 pm
Location: Brooklyn, New York

Postby HappyPoet » Sun Dec 19, 2010 5:22 pm

Hi Dr. Sclafani,

A quick question: If there is no obstruction reflux into the deep cerebral veins shown on TC DUS, does that mean there never has been and there never will be such reflux?

Thanks!
User avatar
HappyPoet
Family Elder
 
Posts: 1401
Joined: Thu Jul 09, 2009 3:00 pm

Postby drsclafani » Sun Dec 19, 2010 6:59 pm

HappyPoet wrote:Hi Dr. Sclafani,

A quick question: If there is no obstruction reflux into the deep cerebral veins shown on TC DUS, does that mean there never has been and there never will be such reflux?

Thanks!


no, these studies are phasic in nature.
User avatar
drsclafani
Family Elder
 
Posts: 3132
Joined: Fri Mar 12, 2010 4:00 pm
Location: Brooklyn, New York

Postby CuriousRobot » Sun Dec 19, 2010 7:17 pm

Dr Scalfani:

You once wrote of asking the Italian doctors why they enter through the left iliac femoral venous axis and not the right (something about it being easier, a straight shot, through the right than the left).

Have you found that going through the left is truly warranted in your research so far? Do you feel that by entering through the right, a doctor may miss something?

Thanks,
Przemek
User avatar
CuriousRobot
Family Elder
 
Posts: 173
Joined: Tue Nov 02, 2010 4:00 pm

Re: Follow up CCSVI report..

Postby Nunzio » Mon Dec 20, 2010 2:35 am

Cece wrote:
Nunzio wrote:In the future I envision using external stents to prevent extrinsic compression of the Jugular vein. I know Dr.Noda was releasing the scalene muscle to prevent compression.
The same concept goes for people claiming they have the carotid bulb indenting the Jugular vein.

By external stents, do you mean around the vein from the outside, put in surgically? I don't think it would work by the carotid, because internally or externally, an IJV stent would put pressure on the wall of the carotid, possibly causing slow heart beat or other issues.
Your problem is that Gazelle have a long neck prone to these misalignment problems. If you were an Hippopotamus with a short neck, you might be just fine even though "lady Hippopotamus" doesn't have the same ring as "lady Gazelle"
Good luck on your new treatment.

:) :D

Yes Cece, That was what I meant, I agree with you about the carotid bulb;if you rub on it you can lower somebody blood pressure significantly; that is why is important to understand that the problem is whatever is on the other side pushing the Jugular vein against the carotid bulb and that could be addressed surgically too, maybe " a la Noda"
Everybody here brings happiness, somebody by coming,others by leaving.  PPMS since 2000<br />
User avatar
Nunzio
Family Elder
 
Posts: 254
Joined: Thu Jan 14, 2010 4:00 pm
Location: South Florida

Etiology of Lesions

Postby Squeakycat » Mon Dec 20, 2010 2:53 am

Mark Haacke provides an excellent overview of the relationship between CCSVI and MS lesions and symptoms that we have been discussing here in an Expert-Review editorial:

Chronic cerebral spinal venous insufficiency in multiple sclerosis
E Mark Haacke
Expert Review of Neurotherapeutics, January 2011, Vol. 11, No. 1, Pages 5-9.

Immune System Reaction to Venous Reflux
In a recent review of the role of venous reflux, Simka stated: “It is hypothesized that pathological refluxing venous flow in the cerebral and spinal veins increases the expression of adhesion molecules, particularly ICAM-1, by the cerebrovascular endothelium” [16]. Along these lines, Bergan demonstrated, by occluding a major vein in the rat, that the number of leukocytes migrating across the vessel wall increased progressively during occlusion [17–19]. Multiple microhemorrhages occurred upstream of the occlusion (usually 20–30 µm in diameter, but some as large as 200 µm). “The venular occlusion experiments showed that reduced flow can rapidly set in motion an inflammatory cascade, including hallmarks like leukocyte adhesion to the endothelium, migration into the interstitium, free radical production and parenchymal cell death that begins soon after occlusion…” Bergan goes on to say: “Elevated pressures can also cause the formation of transcellular gaps through endothelial cells, which may be related to the development of microhemorrhages.”


Mechanical blood flow and MS
In the 1980s, Schelling believed that there was a significant mechanical nature related to the fact that the vascular damage follows a path opposed to the flow [20]. He quotes Carswell as saying: “In inflammation, the local congestion commences in the capillaries, afterwards extends to the small veins, but never to large branches; in mechanical congestion (by venous flow inversion) the blood accumulates first in the venous trunks, which are always conspicuous, and afterwards in the branches and capillaries.” [21]. Further evidence of this mechanical effect comes from observations of Allen, who noticed the widened vascular beds around veins and the central widening of the venous tree indicative of intermittent increases in cerebral pressure [22]. It is also worth looking into Fog’s work. He summarizes his results from a series of cadaver brain studies as “thirty plaques showed that they definitely followed the course of the veins, so that course and dimensions of the veins determine the shape, course and dimension of the plaques.” [23]. He also closes his work with the comment: “Consequently, multiple sclerosis, pathologico-anatomically, must be considered a periphlebitis, as proved by the author in 1948 in the case of plaques of the spinal cord.” [24].


Perfusion Deficits in Multiple Sclerosis
Recently, it has been demonstrated that there is reduced perfusion and even loss of small medullary vein visibility in MS [8]. Juurlink discusses the role of hypoperfusion in MS [25]. He comments that the reduced perfusion can be detrimental to oligodendrocytes, preferentially affects white matter, causes demyelination and leads to microglial activity. He notes that these can be most marked in the optic nerve and tract. He then states: “There is now ample evidence that ischemic insults of sufficient severity can cause upregulation of cell adhesion molecules onto the endothelial cells, thus allowing infiltration of leukocytes into the brain parenchyma, resulting in an inflammatory lesion.” He goes on to point out that hypertension of genetically susceptible lesions leads to vascular damage, which in turn leads to ischemia. There is actually a body of evidence suggesting reduced perfusion in MS patients. Back in the 1980s, Swank et al. found that past the age of 40 years, MS patients had markedly reduced blood flow compared with normal individuals [26]. Using MRI, there has been a thrust in the last 10 years to study perfusion in MS. The work of Meng Law [27] and others [28–32] demonstrates that there is reduced perfusion as a function of severity of disease. Law et al. reported a significant decrease of cerebral blood flow and a prolongation of mean transit time in the normal-appearing white matter (NAWM) at the level of the lateral ventricles in MS patients [27]. These reductions often appear in the basal ganglia and thalamus and have been related to fatigue [30,31,33]. A study of seven patients with relapsing– relapsing–remit- remit remitting MS revealed decreased relative cerebral blood volume (CBV) in chronic lesions and further reduced relative CBV in one acute lesion in white matter compared with that in gray matter [27].
User avatar
Squeakycat
Family Elder
 
Posts: 410
Joined: Fri Dec 04, 2009 4:00 pm
Location: Yehud, Israel

Postby drsclafani » Mon Dec 20, 2010 6:37 am

CuriousRobot wrote:Dr Scalfani:

You once wrote of asking the Italian doctors why they enter through the left iliac femoral venous axis and not the right (something about it being easier, a straight shot, through the right than the left).

Have you found that going through the left is truly warranted in your research so far? Do you feel that by entering through the right, a doctor may miss something?

Thanks,
Przemek

i have not changed my treatments by beginning on the left side. However, i believe I have been able to better assess the global drainage problems and counsel patients better.
User avatar
drsclafani
Family Elder
 
Posts: 3132
Joined: Fri Mar 12, 2010 4:00 pm
Location: Brooklyn, New York

Postby L » Mon Dec 20, 2010 8:12 am

Hi Dr Sclafani

I was treated by Dr Tariq just over two weeks ago in Alexandria. As a result I got a thrombosis in my left jugular (the ultrasound showed there to be no flow prior to treatment there at all and afterwards too, hopefully due to the thrombosis which will hopefully pass.) Anyway, I am seeing my neurologist tomorrow to discuss this and to possibly receive an ultrasound/get a referral to a venous specialist. I've been on Clexane and Plavix and I'm keeping my fingers crossed.

Here's my question though. A booklet which we received recommended that we sleep inclined at 30°. I'd often thought about trying inclined bed therapy but was too lazy to get round to doing it so I happily slept on three pillows every night since my treatment in Egypt. But I was just thinking this morning - wouldn't it make more sense to sleep flat on my back and keep the jugular veins open (or as open as possible) since I'm hoping to shift the thrombosis? Does the thrombosis has less chance of dissipating when the veins are closed?

A related question - does utilising the jugular system have any advantage at all? I mean, in theory, would someone feel just the same effects as jugular venoplasty if they slept sitting up and never lay down again or does opening closed jugular veins have an advantage over never using the jugular system at all, in terms of draining blood from the brain and eliminating reflux? I'm thinking of people who experience remarkable improvements following the procedure - I'm guessing that they wouldn't have felt so good from a night with three pillows..
User avatar
L
Family Elder
 
Posts: 946
Joined: Sat Oct 20, 2007 3:00 pm
Location: The United Kingdom

Postby Lyon » Mon Dec 20, 2010 9:17 am

..
Last edited by Lyon on Thu Jun 23, 2011 6:13 pm, edited 1 time in total.
Lyon
Family Elder
 
Posts: 6063
Joined: Wed May 03, 2006 3:00 pm

Naysayer question

Postby MarkW » Mon Dec 20, 2010 9:34 am

What a loaded question..............MarkW
Mark Walker - Oxfordshire, England. Registered Pharmacist (UK). 11 years of study around MS.
Mark's CCSVI Report 7-Mar-11:
http://www.telegraph.co.uk/health/8359854/MS-experts-in-Britain-have-to-open-their-minds.html
User avatar
MarkW
Family Elder
 
Posts: 1149
Joined: Thu Oct 19, 2006 3:00 pm
Location: Oxfordshire, England

PreviousNext

Return to Chronic Cerebrospinal Venous Insufficiency (CCSVI)

 


  • Related topics
    Replies
    Views
    Last post

Who is online

Users browsing this forum: No registered users


Contact us | Terms of Service