Candy canes are for christmas. I do not accept the "candy cane" as significant. it is described in the azygos vein but when you take a deep breath this narrowing goes away completely.1eye wrote:The left seems to have a candy-cane twist and the dye seems to pool lower down. Looks like a septum or something is holding it in? The right seems non-existent, and if no dye is getting past the jugulars at all, maybe there just aren't enough others and collateral veins, to handle what should be the jugulars' flow in prone position?
Also, I had another question. Do you examine or what the flow looks like in both upright and prone? Not to treat spinal veins, but just as a double-check before treatment??
pelopidas wrote:Cece wrote:It could be a clot, and if it's a removable clot, all the better. Or there could be agenesis (of the right tranverse sinus) or an over-sized arachnoid granulation.drsclafani wrote:What could be the causes of dural sinus obstruction?
People with CCSVI could be at increased risk for sinus thrombosis due to flow being slowed because of jugular obstructions; it certainly seems to follow.
..and some kind of tumor
NZer1 wrote:I'm guessing here but the way the flow reverses and the region around the brain stem/foramen magnum I am suspicious of a Chiari Malformation.
I also get the impression there are 'twists' or internal plaques in veins because of the way that the blood is pooling in places. Really hard to see what is happening in a still one dimension image?
So the diagnosis on the right side is thrombosis of the transverse sinus in addition to right internal jugular vein stenosis at the inferior jugular bulb caused by valvular malformation.
drsclafani wrote:actually the guidewire in figure 8 goes from the left internal jugular vein across the sinuses and down into the right internal jugular vein. That caused me some confusion.
Cece wrote:So the diagnosis on the right side is thrombosis of the transverse sinus in addition to right internal jugular vein stenosis at the inferior jugular bulb caused by valvular malformation.
Treatment is angioplasty of the valve and, for the sinus, either attempted flushing of clot or no treatment or referral to a neurointerventional radiologist partner? If it's a complete impasse, I guess no treatment is the answer. Stenting can be done in sinuses but that's if it was a partial occlusion and this is a complete occlusion? The guidewire does not get through from this side but did you try from the other side?
NZer1 wrote:Dr S the term 'clot' seems very loose.
I have been pondering this case and naturally we all will think, ok,
what has caused the restriction,
when did it happen,
why didn't it resolve naturally,
is there more problems down stream that are slowing the flow,
will this reoccur,
is the 'clot' able to be analysed to find out it's composition,
was this caused by medications,
was it caused by bacteria,
was it caused by diet/plaque,
is there other veins that will have the same issue,
why this particular place,
how long has it taken for the collaterals to form and enable by-pass,
has this occurred due to injury/falls/trauma,
is this going to be a common finding,
if there is 'clotting' is it also happening at capillaries,
how does this link to the symptoms and lesions that this patient has,
are the lesions that this patient has on MRI typical vein centred 'MS' lesions as per Franz Schelling?
There are many more questions of course and my brain is not functional at the moment to think further, but I will keep thinking about this
mo_en wrote:drsclafani wrote:actually the guidewire in figure 8 goes from the left internal jugular vein across the sinuses and down into the right internal jugular vein. That caused me some confusion.
The guidewire goes through both transverse sinuses, doesn't it? Yet, the blood refuses to go down the right one. Maybe, relieving the valvular obstruction will reduce the resistance of this path?
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