This Is MS Multiple Sclerosis Community: Knowledge & Support

It has been a while since I had the time to show an interesting case here.

This 41 year old woman visited me recently from Ankara turkey where she had previously undergone two venograms and venoplasties.
She had multiple angioplasties that resulted in clinical improvements during the first treatment. These improvements were short lasting, so she returned for another "more aggressive treatment a few months later.. She stated that no pain medications were given and that the procedure was quite painful. This treatment did not result in any return of improvements. She believed that her walking actually deteriorated after this treatment.

On my assessment she was a well dressed, organized, oriented, well speaking woman. She had weakness in both lower extremities, abnormal Rhomberg test, absent gag reflex, nystagmus and positive Babinski. Her gait was abnormal and she walked with a cane.

I performed venography which i begin to show you now.

The image below shows both internal jugular veins and a vertebral vein.

Can you tell me which is which?

what abnormalities do you see??

The left jugular appears blocked. Irregular appearance down at the area of the valves with dark contrast, and the usual CCSVI appearance of a cluster of small collaterals at the top of the jugular.

DrS, now that we know she has spinal lesions, a general question: IIRC, according to Dr. Schelling's theory, the lowest spinal cord lesion will be at the lowest point of reflux. What modalities can image how far down the VVP such reflux travels?

I cannot answer that. With the discovery of the potential impact of the Nutcracker syndrome , reflux can extend down to the bottom of the spinal cord. Remember that the spinal cord ends around the twelfth thoracic vertebra also the perivertebral plexus extends down to the sacrum