Dear, highly esteemed, colleagues,
Thank you for granting me insight into these crucial pieces of
evidence regarding the vein-dependence of Mr. Wiercinski's
cerebrospinal lesion developments.
The scans of SE 5007, MPR Range 2 clearly show the Dawson's fingers'
emergence from most central branches of the inner cerebral veins. An
impressive peculiarity is the destruction of the corpus callosum
between its middle and posterior length, corresponding to a crossing
of sub- and epicallosal veins (scan 60/121).
As shown especially on the same series' scans 63-65/121 , these lesion
veins actually relate, via straight sinus and a short-cut along an
unusually broad occipito-marginal sinus, mainly to the right internal
jugular vein. This vein, being distinctly widened above its valvular
ring, appears rather narrowed where it is contacted by the carotid
artery (scans 81-87/121).
The same applies to the left internal jugular vein on its crossings
with an arterial sling. Being supplied with a patent stent in its
valvular ring, this left jugular vein yet merely connects to the
straight sinus via a small tentorial sinus and a tiny bridge to the
left transverse sinus: It therefore cannot have much impact on inner
cerebral and plaque veins.
The drainage of the cerebral cortical veins takes its usual course via
superior sinus sagittalis and right lateral sinus to the right
internal jugular vein.
In regard of the presence of upper spinal lesions as well, the
elucidation of course and nature of the disturbances affecting the
dominant right internal jugular vein's flow - having a preeminent
influence on cerebrospinal fluid displacements as well - obtains
It needs to be found out whether there still previals an unusual
pressure gradient across the valve of the right internal jugular vein,
or whether this valve yields but to exceptionally high intrathoracic
excess pressures (the widening of the vein's proximal part could have
been effected both ways). According to the said scans 81-87/121 of SE
5007, arterial pulsations being transmitted on a right internal
jugular vein - which cannot escape laterally because of muscular
pressure - might also drive its blood back in the venous periphery.
From pictures I saw at Glasgow and in Italy I would expect
endovascular sonography to be the best tool for elucidating the
mechanism which the Dawson's fingers' emergence in Mr. Wiercinski's
brain is effected by. And it also could be found out whether the
description I derived from Mr. Wiercinski's MRV does fit in with the
Your curing Mr. Wiercinski will further improve many another MS patient's fate.
Franz Schelling, M.D.