No association of abnormal cranial venous drainage with MS

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Postby Cece » Mon Nov 01, 2010 10:49 am

MRV < Doppler < Catheter Venogram < Catheter Venogram with IVUS or Catheter Venogram with Sinan's method of Azygous Diagnostic Ballooning
"However, the truth in science ultimately emerges, although sometimes it takes a very long time," Arthur Silverstein, Autoimmunity: A History of the Early Struggle for Recognition
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Postby PCakes » Mon Nov 01, 2010 11:02 am

Cece wrote:MRV < Doppler < Catheter Venogram < Catheter Venogram with IVUS or Catheter Venogram with Sinan's method of Azygous Diagnostic Ballooning


Dr Haacke is working very hard to move MRV up in that ranking and where does fMRI (Dr Hubbard) fit in? or does it?

teacha teacha teeeeach me.. Sorry, Halloween hangover :)
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Postby Cece » Mon Nov 01, 2010 11:17 am

PCakes wrote:
Cece wrote:MRV < Doppler < Catheter Venogram < Catheter Venogram with IVUS or Catheter Venogram with Sinan's method of Azygous Diagnostic Ballooning


Dr Haacke is working very hard to move MRV up in that ranking and where does fMRI (Dr Hubbard) fit in? or does it?

teacha teacha teeeeach me.. Sorry, Halloween hangover :)

I'm not sure. Hmm. I'd say the ones I listed are all directly diagnostic for CCSVI either through structural imaging or hemodynamic flow measurement. Dr. Hubbard's fMRI measures the effects of CCSVI, by measuring the oxygenation or cerebral perfusion both pre- and post-procedure. But it's brilliant too.
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Poor Science in Study

Postby MarkW » Mon Nov 01, 2010 12:11 pm

I have amended very slightly my comment from June 2010:

The Amsterdam VU Medical Centre study said that only 20 patients and 20 healthy controls were participating. The study used Magnetic Resonance Venography rather than the gold standard for diagnosis of CCSVI, which is Selective Venography (SV) as described by Hojnacki D et al. (In the csvi library for TIMSers). The small size of the study and diagnosis method, mean the Dutch work is worthless.

For me, it is like saying: “we looked for a needle in the haystack by visual means but did not use a metal detector. Our conclusion is that there is no needle in the haystack.”

2000 plus people have been de-stenosed after diagnosis with selective venography. This Dutch study is poor science and meaningless in size against 2000 real pwMS. Let's move on to real science not this rubbish.
Read Sclafani's paper on how to diagnose it you want to learn more.

MarkW
Mark Walker - Oxfordshire, England. Registered Pharmacist (UK). 11 years of study around MS.
Mark's CCSVI Report 7-Mar-11:
http://www.telegraph.co.uk/health/8359854/MS-experts-in-Britain-have-to-open-their-minds.html
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Postby malden » Mon Nov 01, 2010 12:31 pm

Abstract
...
Flow quantification showed no venous backflow in any MS patient or control.
...

Venous backflow alias "Reflux in the brain" is a Bogeyman of CCSVI theory, monstrous imaginary figure used in threatening MS-patients. This legendary monster has no specific appearance, no evidence of existing, non explainable by any hemodynamic theory. He simply has no set appearance, but is just an amorphous embodiment of terror. Just endless repeating .... If you are not Liberated, the bogeyman will get you and eat your brain!
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Postby Sotiris » Mon Nov 01, 2010 12:41 pm

The paper can be found here:
http://www.overcomingmultiplesclerosis. ... ntId=20084
(there is a small delay in displaying the pdf)
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Re: Poor Science in Study

Postby Lyon » Mon Nov 01, 2010 12:58 pm

MarkW wrote: 2000 plus people have been de-stenosed after diagnosis with selective venography. This Dutch study is poor science and meaningless in size against 2000 real pwMS. Let's move on to real science not this rubbish.
Read Sclafani's paper on how to diagnose it you want to learn more.
I've seen people here at thisisms try to add up ballpark figures but it's never been evident there are any trustworthy numbers on how many people have had venous angioplasty for CCSVI. Confounding the situation even more is the consideration that a good number of people have been treated more than once and it's essential to be differentiate "number treated" from "procedures performed".

MarkW wrote:This Dutch study is poor science and meaningless in size against 2000 real pwMS. Let's move on to real science not this rubbish.
I agree with your points about the Dutch study but it's also important to point out that, in kind, there isn't "real science" and only "rubbish" to compare it to.

Even if it were true that 2000 people have been treated with venous angioplasty for CCSVI, proper studies haven't been done capable of proving that any of them were "successful" and more than that, no one has officially kept track of the number treated or percentage of patient claimed results or the number of positive and negative results claimed but it is certain that a sizable percentage are having less than positive results.

Point is that if there were 2000 treated so far, it's not fair nor accurate to throw that number around as if the entire number were positive results.

Worse, the above situation you refer to by and large involves ONLY people who have sought a CCSVI diagnosis and treatment who, by a preponderance, have MS. With it in mind that the most elementary factor of disease research is comparing those with disease to those without disease in order to identify and hopefully rectify the differences, it's essential to again stress that it's yet to be convincingly proven with equal testing methods that CCSVI is unique to those with MS and is uncommon in "normals".
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Postby Leonard » Mon Nov 01, 2010 1:00 pm

scorpion wrote:
Jugular wrote:[b]
Leonard said:

I think that some people may have stronger veins (more Vit D during their childhood/ their mother metabolised more sun during pregnancy?), veins that are less susceptible to microbleedings. so, maybe, some people will also have stenoses but do not develop MS for that reason.

Is this something that has been proven or is it a wild guess?

Leonard said:
in any event, those with the weaker veins and MS benefit from liberation. that is the ultimate test! not whether other people happen to have stenoses and no MS.


Once again can you please let me know where you discovered that "those with weaker veins and MS benefit from liberation" Although there are some blinded studies in the woodworks, no one can make an ABSOLUTE claim about anything at this point.


Scorpion, you are right, it is a wild guess at this point. But fact is that those who have moved to southern regions during their childhood (more sunlight, vit D?) have lower chance of developing MS. Fact is also that Vit D strengthens the binding tissue of the vessels. So, if MS is caused by immune cells penetrating into the vessel wall (BBB) by microbleedings, this all makes sense.
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Postby cheerleader » Mon Nov 01, 2010 1:04 pm

Sotiris wrote:The paper can be found here:
http://www.overcomingmultiplesclerosis. ... ntId=20084
(there is a small delay in displaying the pdf)


thanks for the full paper, Sotiris. Even having spent time with Dr. Haacke discussing his protocol and time of flight 3D imaging and the reflux he is seeing, I am hard-pressed to find any problems with this study (except for the small sample size) I've forwarded to the good doctor and asked for his thoughts. I will post them if he OKs that.

This caveat in the paper caught my attention

We have to be aware that all available standard imaging approaches for the evaluation of the cranial venous system represent rather a snapshot. The venous blood flow is influenced by many different physiological factors and their interaction such as respiratory changes, swallowing, central venous pressure, position of the patient (supine, sitting, upright), muscle contraction, etc. Regarding the analysis of the intracranial and cervical venous systems, it is almost impossible to take all of these factors into account, regardless of the imaging modality used.


The pictures included were lovely, with gorgeous, open veins and nothing like the pics I've been seeing of MS patients from Dake and Haacke's MRVs. And not like Jeff's mangled jugulars and squirrelly collaterals at all....
Image

cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby Cece » Mon Nov 01, 2010 1:10 pm

Malden wrote:Venous backflow alias "Reflux in the brain" is a Bogeyman of CCSVI theory, monstrous imaginary figure used in threatening MS-patients. This legendary monster has no specific appearance, no evidence of existing, non explainable by any hemodynamic theory. He simply has no set appearance, but is just an amorphous embodiment of terror. Just endless repeating .... If you are not Liberated, the bogeyman will get you and eat your brain!

this was posted yesterday in Dr. Sclafani's thread, it may help show how venous reflux is described in Doppler exams, I have bolded some relevant parts:
drsclafani wrote:LET ME TRY TO INTERPRET THIS INTO ENGLISH FOR YOU. MY TRANSLATION WILL FOLLOW PART OF THE REPORT IN ALLCAPS


REPORT


SUPINE STUDY:

Right IJV Cross-sectional area: 17.5mm^2
Left IJV Cross-sectional area: 30.5mm^2


IN THE LYING DOWN POSITION, THE LAB HAS MEASURED THE AREA OF THE CIRCUMFERENCE OF THE JUGULAR VEIN. AS YOU CAN SEE THE AREA OF THE LEFT IS ALMOST TWICE THAT OF THE RIGHT. HOWEVER COMPARISON OF RIGHT AND LEFT DO NOT HAVE SIGNIFICANCE. COMPARISON OF LYING DOWN AND SITTING UP IS IMPORTANT.

Prominent echogenic bands in the J1 segment of the left IJV
ECHOGENIC BANDS ARE SOUND REFLECTIONS OF TISSUE, IT COULD BE BANDS, ABNORMAL VALVES, SEPTATIONS, ETC THIS IS A B-MODE ABNORMALITY


Intermittent retrograde flow in the J2 segment of the left IJV
PERIODIC FLOW BACK UP TOWARD THE HEAD IN THE MIDDLE OF THE JUGULAR VEIN. THIS IS ABNORMAL. WE CALL IT REFLUX.

[b]Normal antegrade flow in the right IJV, vertebral, and deep cerebral veins.

BUT THAT REVERSED FLOW ONLY OCCURS IN THE LEFT INTERNAL JUGULAR VEIN. THE OTHER MEASURED VEINS HAVE FLOW IN THE CORRECT DIRECTION. THIS ZAMBONI CRITERIA IS MET WHEN ANY OF THE VEINS FLOW BACKWARD. YOU DO NOT HAVE TO HAVE IT IN MORE THAN ONE OF THE VEINS.


UPRIGHT STUDY: USUALLY DONE SITTING UP, NOT STANDING.

Right IJV Cross-sectional area: 21.4mm^2 (change from supine= -3.9mm^2

THE CROSS SECTIONAL AREA DIFFERENCE BETWEEN UPRIGHT AND LYING DOWN ON THE RIGHT (ALSO KNOWN AS DELTA CSA). WHEN YOU SUBTRACT THE UPRIGHT FROM THE SUPINE AND GET A NEGATIVE NUMBER, THAT MEANS THAT THE CSA IS LARGER UPRIGHT THAN SUPINE. NORMALLY THE VEIN GETS SMALLER WHEN YOU ARE UPRIGHT BECAUSE THE FLOW NORMALLY GOES THROUGH THE VERTEBRAL VEIN WHEN SITTING AND STANDING.

Left IJV Cross-sectional area: 4.8mm^2(change from supine= +25.7mm^2
THIS IS WHAT IS NORMALLY SUPPOSED TO HAPPEN. THE VEIN IS BIGGER SUPINE THAN UPRIGHT.

Normal antegrade flow in the IJV and vertebral veins

ANTEGRADE FLOW MEANS THAT THE FLOW IN THE VEIN IS BACK TO THE HEART. tHIS IS THE DIRECTION VENOUS BLOOD IS SUPPOSED TO GO.

Retrograde flow in the deep cerebral veins
THE FLOW IN THE DEEP CEREBRAL VEINS IS GOING BACK TOWARD THE HEAD. THIS IS NOT WHAT IS SUPPOSED TO HAPPEN;. THIS IS ABNORMAL. THIS IS THE PART OF THE TEST THAT IS DONE WITH THE PROBE AGAINST THE TEMPLE OR NEAR THE EAR. IT IS CALLED TRANSCRANIAL DOPPLER.


INTERPRETATION:

1. Criteria for CCSVI 4/5 (qualifying factor for CCSVI is 2/5)
THE FIVE CRITERIA ARE
1. REVERSAL OF FLOW IN AN IJV OR VERTEBRAL VEIN (YOU HAVE THIS)
2. REVERSAL OF FLOW IN THE DEEP CEREBRAL VEINS (YOU HAVE THIS)
3. ABSENCE OF FLOW FOR PART OF THE VASCULAR CYCLE(YOU DO NOT HAVE THIS)
4. A NEGATIVE DELTA OF CSA (YOU HAVE THIS)
5. B-MODE ABNORMALITIES LIKE STENOSES, THICK VALVES, (YOU HAVE THIS)

I hope this helps[/b]
"However, the truth in science ultimately emerges, although sometimes it takes a very long time," Arthur Silverstein, Autoimmunity: A History of the Early Struggle for Recognition
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Postby Jugular » Mon Nov 01, 2010 2:13 pm

cheerleader wrote:The pictures included were lovely, with gorgeous, open veins and nothing like the pics I've been seeing of MS patients from Dake and Haacke's MRVs. And not like Jeff's mangled jugulars and squirrelly collaterals at all....
cheer
Cheer, you cheered me up for sure! I would really like to hear what Haacke has to say about this study. But you're right, from the figures, both the MS and control subjects in the study appear to have enviable veins.

Perhaps the Dutch, even those with MS, are beautiful people with lovely veins???

I almost feel like saying, ala Crocodile Dundee, you're calling that a stenosis mate?

THIS is a stenosis.


Image
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Postby Johnson » Mon Nov 01, 2010 2:45 pm

Jugular wrote:
cheerleader wrote:The pictures included were lovely, with gorgeous, open veins and nothing like the pics I've been seeing of MS patients from Dake and Haacke's MRVs. And not like Jeff's mangled jugulars and squirrelly collaterals at all....
cheer
Cheer, you cheered me up for sure! I would really like to hear what Haacke has to say about this study. But you're right, from the figures, both the MS and control subjects in the study appear to have enviable veins.

Perhaps the Dutch, even those with MS, are beautiful people with lovely veins???

I almost feel like saying, ala Crocodile Dundee, you're calling that a stenosis mate?

THIS is a stenosis.


Pshaw! Do you call that a stenosis? I'll see your stenosis, and raise you two - a la Alligator Johnson (but not really).

I'm not really trying to one-up any one, I just need an excuse to admire my neck again...

Image

Image

Laugh with me.

Jeff has cuter, curlier collaterals than either of us, Jugular.
My name is not really Johnson. MSed up since 1993
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Postby Cece » Mon Nov 01, 2010 2:56 pm

Nope, of all the CCSVI images that have been shared here, none of them were pretty and flowing like that. Huh. (Jugular and Johnson,yup! That is more like it.)

* small sample size
* selection bias in the sample or conversely we have a selection bias here (only people with whom CCSVI theory resonates are pursuing this as aggressively as we are?)
* too much contrast used in the MRV?
* the Dutch are beautiful and have beautiful veins (credit to jugular)
* too low of a bar set for determing what's a stenosis, thus the control group numbers are higher than they should be
* lack of information on azygous due to its inability to be imaged
* Haacke protocol used?
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Postby Jugular » Mon Nov 01, 2010 3:01 pm

Johnson wrote:Pshaw! Do you call that a stenosis? I'll see your stenosis, and raise you two - a la Alligator Johnson (but not really).

I'm not really trying to one-up any one, I just need an excuse to admire my neck again...

Laugh with me.

Jeff has cuter, curlier collaterals than either of us, Jugular.


Well, granted, Jeff's curly collaterals are quite fetching, but I would like to argue that the slim mid-section and barrel shaped upper body appearance to my RIJV would be quite attractive to the ladies. Well, come to think of it, it looks more like skinny legs and barrel shaped belly.

Either way, you've got us both outguned. :lol:
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Postby cheerleader » Mon Nov 01, 2010 3:44 pm

ROTFLMAO...
I love the Ug-Jug contest. (I'll see your stenosis and raise you two curly collaterals..)
Guess those nordic people really have won the DNA lottery. Hope Dr. Haacke gets back to me. Would love to get his take on all of this.
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dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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