low blood pressure & hypoperfusion related to brain atrophy

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

low blood pressure & hypoperfusion related to brain atrophy

Postby Cece » Fri May 25, 2012 7:42 am

http://www.medpagetoday.com/MeetingCove ... id=5517461
Among more than 4,000 individuals followed throughout their lifetime, low diastolic blood pressure around age 75 was associated with smaller brain volume, but only among those who had had hypertension around age 50, according to Majon Muller, MD, PhD, of the National Institute on Aging in Bethesda, Md.

The proposed mechanism: hypertension in mid-life causes structural changes in the brain that result in a disturbance in the autoregulation of the cerebral blood flow, making the brain more vulnerable to low blood pressure and hypoperfusion in late-life, Muller said here at the American Society of Hypertension meeting.

If hypoperfusion can contribute to brain atrophy, as suggested here, and patients with MS have both hypoperfusion and brain atrophy, and there is a simple procedure such as jugular venoplasty that can improve the blood flow from the brain, thus reducing hypoperfusion, then to me it is still a no-brainer to seek treatment for our jugular malformations.
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Postby MarkW » Fri May 25, 2012 9:04 am

Cece wrote:If hypoperfusion can contribute to brain atrophy, as suggested here, and patients with MS have both hypoperfusion and brain atrophy, and there is a simple procedure such as jugular venoplasty that can improve the blood flow from the brain, thus reducing hypoperfusion, then to me it is still a no-brainer to seek treatment for our jugular malformations.

I recommend that we fix all stenoses Cece, not just the ones in the jugulars. No one knows if it OK to leave stenoses in other major veins in the neck and trunk. So treat all stenoses in all patients not just pwMS as CCSVI syndrome could impact other neurovascular conditions and ageing.
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Re: low blood pressure & hypoperfusion related to brain atro

Postby msscooter » Sat May 26, 2012 12:02 am

Dr Chung from Taiwan has found acquired venous stenosis in seniors it increases with age. very likely over age 75.
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Re: low blood pressure & hypoperfusion related to brain atro

Postby Cece » Sat May 26, 2012 8:51 am

I love Dr. Chung's research. It wouldn't be classified as acquired stenosis (as far as I am aware) but as acquired insufficiency of the jugular valves. The valves don't thicken and make roadblock outflow obstructions as is found in us; the valves weaken and let flow go through in both directions. This reflux may lead to some of the white matter lesions that are age-related. Ironically this is the GOAL of ccsvi venoplasty: to make our valves weak which will let flow go through in both directions. It's better for us than keeping the flow in, but it's still not what healthy people get, which is functional jugular valves that would let flow out and keep flow from coming back. It's a reason not to allow healthy valves to be ballooned and destroyed, so it is good if your IR uses IVUS like Dr. Sclafani and Dr. Cumming etc or has some way to distinguish between a healthy valve and a nonhealthy valve. It seems more common for stenosed valves to have gone untreated than for healthy valves to be treated, because it seems that healthy valves in a pwMS are few and far between, but it would be good to have exact numbers on that.
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Re: low blood pressure & hypoperfusion related to brain atro

Postby msscooter » Sat May 26, 2012 12:29 pm

Here is Dr Chung's interview from ISNVD. http://www.youtube.com/watch?v=J1AJK2NRZp8. She and Dr Hu believe the left brachycephalic vein, also known as the innominate (no name) becomes compressed as people age and this causes reflux. the stenosis then may occur further up the vein in response to low blood flow or turbulent flow. Don't think they found age related valve changes, seemed like they were mostly talking about brachycephalic vein. I spoke with both of them at length as they think this may be my primary problem. I have "progressive MS" and I have aways had banding pain. Now i have wild BP fluctuations and a new bulging vein on the left side of my chest. Drs Hua and Chung think it is my brachycephalic vein. I'm trying to convince my doc to test me for this. it is working....... slowly. Charcot's first description of MS includes the banding pain or "MS hug"...
Dr Hu said something interesting in his keynote talk: Taiwan has almost no MS. But they see a lot of this and have been treating it for years with stents. Very risky stents. they have high migration rate. need expert placement.........
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Re: low blood pressure & hypoperfusion related to brain atro

Postby Cece » Sat May 26, 2012 1:32 pm

msscooter wrote:Here is Dr Chung's interview from ISNVD. http://www.youtube.com/watch?v=J1AJK2NRZp8. She and Dr Hu believe the left brachycephalic vein, also known as the innominate (no name) becomes compressed as people age and this causes reflux. the stenosis then may occur further up the vein in response to low blood flow or turbulent flow. Don't think they found age related valve changes, seemed like they were mostly talking about brachycephalic vein. I spoke with both of them at length as they think this may be my primary problem. I have "progressive MS" and I have aways had banding pain. Now i have wild BP fluctuations and a new bulging vein on the left side of my chest. Drs Hua and Chung think it is my brachycephalic vein. I'm trying to convince my doc to test me for this. it is working....... slowly. Charcot's first description of MS includes the banding pain or "MS hug"...
Dr Hu said something interesting in his keynote talk: Taiwan has almost no MS. But they see a lot of this and have been treating it for years with stents. Very risky stents. they have high migration rate. need expert placement.........

thanks, I'll watch that.
If they are only seeing and treating it in older patients, I wouldn't expect it to have much impact on the rates of MS, since MS is usually diagnosed between the ages of 20-40. I wonder if they are treating it in younger patients too. This all makes me not want to age....
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Re: low blood pressure & hypoperfusion related to brain atro

Postby 1eye » Sat May 26, 2012 1:47 pm

I was diagnosed at 44, though my first attack was maybe at 29. I have only recently started to recognize the 'hug', though it is not yet causing pain.

I think I'm in the older onset group.
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Re: low blood pressure & hypoperfusion related to brain atro

Postby Cece » Sat May 26, 2012 1:48 pm

Chung's research does mention the brachiocephalic vein. I'd forgotten about it.
http://tinyurl.com/6s7hqnb
http://www.neurology.org/content/66/12/1873.short

I wonder if the brachiocephalic compression is what causes the jugular valve to become insufficient, if there is too much backward pressure on it and it causes the valve to weaken. Just as valves weaken in the legs.

here's an article discussing the jugular valve insufficiency in people with transient global amnesia:
http://stroke.ahajournals.org/content/41/1/67.short

Would a brachiocephalic compression cause blood flow coming in from the subclavian to divert up the jugular? If a person were getting a jugular valve opened and were also seen to have a brachiocephalic compression, it would make sense to get that treated at the same time. Keep everything open. A few months ago Dr. Sclafani shared a case of a patient who had a brachiocephalic (innominate) compression. His opinion if I recall was that it warranted stenting, but the patient may have held off in the hopes of having it treated in Canada.

Here's the case and, yes, the blood flow from the arm was being rerouted up the jugular because of the brachiocephalic compression: www.thisisms.com/forum/chronic-cerebros ... ml#p182795
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Re: low blood pressure & hypoperfusion related to brain atro

Postby Cece » Sat May 26, 2012 2:02 pm

Msscooter, on a separate topic, did you hear during his presentation about Dr. Chung's animal model of venous reflux? What animal and what if any results? He mentioned it in his abstract but I don't remember hearing anything more.
chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic19335.html

If you can get tested for the compression, do you feel safe having it treated by a nonexpert? Assuming there are no experts outside of Taiwan! I wonder why the vein has the high migration rates; probably it is variable in size due to respiration. Certainly if it does migrate, it's a terrible location because it'll go the heart.
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