My m.s. symptoms did flare up the (late) day after the procedure, overwhelming fatigue, imbalance, etc., and didn't subside yet.
Is this normal, what are your thoughts? Next procedure is Jan.12th,
It is late. I just read this email and it is so important i wanted to share it. I have written about this particular scenario in the past. this is the second such patient and it bears discussing because it quite clearly has some implications.
The patient has MS and came to me after she had undergone a few procedures by others with some improvements. She was not asking me to treat her CCSVI but rather to treat her pelvic congestion symptoms. Rectal pain, pelvic floor fatigue, varicose veins in the thighs, childhood fatigue were among her symptoms. She had an MRI that showed extensive venous congestion in the pelvis, a dilated ovarian vein and nutcracker phenomenon.
I chose to treat her problems in a staged fashion, initially treating the incompetent ovarian vein by coil embolization and sotradechol foam sclerotheraphy. There were two branches of the ovarian vein that connected with a very large internal iliac vein in the pelvis.
We planned her second treatment, to stent the renal vein, for january 12th.
As you can see in her report to me tonite, her ccsvi symptoms dramatically worsed after closing off the ovarian vein flow. Like the prior patient I reported here last year, symptoms worsed after closing the refluxing ovarian vein. Unlike the other patient, she does have MS and CCSVI independent of the sequellae of the nutcracker and pelvic congestion.
why should this happen? I think it is quite simply explained by the anatomy and physiology.
There are three veins that are the major collaterals when the left renal vein has compressive occlusion of the outflow of the left renal venous circulation, namely the ovarian vein, the hemiazygo-renal trunk and the ascending lumbar vein. In this patients case, closing of the ovarian vein flow basically shunted the high flow renal venous output into the hemiazygous vein and perhaps the ascending lumbar vein. these two veins are direct contributions to the cerebrospinal venous circulation. As the renal vein flow is comparable to the cerebral venous flow, this is a tremendous increase in circulation and I believe it is causing venous congestion and possible reflux
I have asked the patient to come in for treatment as soon as possible.
I think these cases are important because they represent direct evidence of cerebrospinal venous insufficiency.
It takes a long time to make those images, sometimes hours. being it so close to the holidays, i cannot spare the time to make pictures but can share the case.