Things do go in threes.....Yesterday another patient was treated. This patient with chronic severe headaches, concentration problems, and easy fatigability DID NOT HAVE MS. though by many to have an environmental toxin problem (doubt), he had an ultrasound done at BNAC which showed three of the five criteria.
After several other interventionalists turned him down, he came to me and I agreed to do a diagnostic venogram, (with little expectation of finding anything.
Take a look at this neck venogram.....Picture on the right look familiar?
which of the three would you think would have the worst symptoms?
Image #1 is not a neck venogram, so I'm ruling this image out of contention.
Image #1 Second try: a short, totally blocked yet fully flowing IJV means dye can quickly reflux back into the dural sinuses, perhaps even into the deep cranial veins before the dye finds routes downward. Seems like it could be difficult to fix, depending on whether or not the IJV continues below where the dye stops and if the vein does continue, if there are anymore stenoses, such as at the valve. My guess is still #3.
Image #2 is not a familiar-looking image; could it be a side view of the neck? Looks like there is rapid flow down collaterals, so I'm ruling this image out of contention.
Image #3 looks like the mother's and son's images in the previous case -- the hypoplastic IJV has a severe stenosis, which completely blocks the flow of dye.
My guess is #3, BUT NOT because the first two images are eliminated but rather because the velocity of the blood first coming down the IJV and then having to be refluxed back up the IJV will be very slow due to the tiny diameter the entire length of the IJV. Also, there are no freely flowing collaterals present which means the route down must be through the dural sinuses, a time-consuming detour.
Refluxed blood could be forced back up into the deep cranial veins before finding a route down which would result in severe hypoxia with the patient's symptoms of severe headache, fatigue, and poor concentration accounted for.
How difficult was it for you to open the L-IJV? What size balloons did you use and how many balloonings did it take to open the entire length of the vein?
Edit #1 I incorporated DrS's post into a quote and added the last paragraph.
Edit #2 I removed my Dr. Tucker paragraph--I don't understand his idea well enough to comment; I get the gist of it, but not the specifics.
Edit #3 For image #1, I tried again because I realized I misunderstood what DrS asked (cogfog).