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The IVUS measurements under discussion are a potentially direct means of determining any haemodynamic standing pressure waves created by venous obstructions. If such pressure waves can measured by IVUS, then through the application of computational fluid dynamics, the amount of hypertension in the area of periventrical lesions could be computed. If this hypertension is sufficiently acute to cause blood-brain barrier breakdown this would provide an explanation for the transport of iron and leukocytes into the cerebral parenchyma. It would also provide a means to estimate the amount of capillary bed ischemia, hence hypoxia, hence loss of oligodendrocytes and hence deterioration of myelin. Leukocytes meet weakened myelin and - voila - MS. If IVUS pressure waveform measurements (systolic and diastolic would suffice) could to be taken at a number of positions going up the vein (IJV?) with a measure of the distance from the obstruction, this could demonstrate that both neurologists and vascular scientists are right. It is an autoimmune disease, but its root cause lies in the venous obstruction causing acute hypertension in the BBB at the venule end of the bed.

The IVUS measurements under discussion are a potentially direct means of determining any haemodynamic standing pressure waves created by venous obstructions. If such pressure waves can measured by IVUS, then through the application of computational fluid dynamics, the amount of hypertension in the area of periventrical lesions could be computed. If this hypertension is sufficiently acute to cause blood-brain barrier breakdown this would provide an explanation for the transport of iron and leukocytes into the cerebral parenchyma. It would also provide a means to estimate the amount of capillary bed ischemia, hence hypoxia, hence loss of oligodendrocytes and hence deterioration of myelin. Leukocytes meet weakened myelin and - voila - MS. If IVUS pressure waveform measurements (systolic and diastolic would suffice) could to be taken at a number of positions going up the vein (IJV?) with a measure of the distance from the obstruction, this could demonstrate that both neurologists and vascular scientists are right. It is an autoimmune disease, but its root cause lies in the venous obstruction causing acute hypertension in the BBB at the venule end of the bed.

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The catheter was placed in the left transverse sinus.
Dural sinus venography looked like this:

(image was in original post)

These images show that the transverse sinus and the sigmoid sinus had normal diameters. However there was a prominent connection between the transverse sinus inside the skull and the vertebral vein and posterior cervical branches on the outside. These vessels are connected by a very large emissary vein traversing across the skull via the hypoglossal canal. This canal is usually a very small opening in the skull but in this patient it is exceedingly large. I think this suggests that a long standing (perhaps congenital) outflow obstruction of the internal jugular vein has existed

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As I have modified my venogram of the dural sinuses, I have noted very prominent emissary veins and these veins provide large conduits increase flow through the spinal veins. I am unclear if there is an association between this emissary vein and symptoms, though.

(I actually emailed dr zamboni about this today!) Wonder what he thinks, although I dont think that dr galleoti routinely images the dural sinuses.

Quote
"why?
Most patients with PPMS have hypoplastic lumbar veins. They are not going to reflux very much "

Hi Dr. welcome back,

* I am wanting to know/learn why spinal cord lesions occur and why it is more common in PPMS?

I am thinking that there must be an association between lesions on the cord itself and blood flows.
Dr Schelling was quite specific that the lesions appeared to be from an action that looked to him like the veins exploding outwards. I naturally assume t

hat would be from reflux/back flow as Dr. Schelling worded it. Trev T has spoken about reverse wave pressures and it would seem logical that with the information from Dr Schelling, Zamboni, and yourself that we dealing with flow restrictions of some kind effecting the region of the cord near the lesions.
If it was a brain lesion there is more variables.
The cord has less 'possibilities'.
Regards Nigel