Serbian case study of extrinsic CCSVI

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

Serbian case study of extrinsic CCSVI

Postby Cece » Mon Jul 02, 2012 3:24 pm

http://www.levecsystem.com/pdf/A%20Case ... erosis.pdf

This must have been discussed here but I can't find it.

This is a case of pediatric MS, diagnosed at age 13, treated for CCSVI at age 23. The patient had previously had angioplasty twice, first to the left jugular and then to both jugulars. This time around, the doctors could find no stenoses within the vein, but found two areas of extrinsic compresion.
No intraluminal IJV stenoses were found, but ARSA was verified with a head compression to trachea and esophagus and secondary brachiocephalic vein obstruction. (Fig. 1) Bilateral IJV distal obstruction by first cervical vertebra transverse process was found as well.

I'm not familiar with ARSA so I'd better keep reading.
The most common aortic arch abnormality is an aberrant right subclavian artery (ARSA), which can be seen in 0.5% to 1.8% of the population.1,2 ARSA can indent the esophagus and the trachea posteriorly, which clinically presents as dysphagia lusoria and airway narrowing.

In this case the aberrant right subclavian artery was compressing the innominate vein.
The doctors chose to not treat. I think they could have stented the innominate vein in the area of the compression. They mention surgical decompression as a possible treatment option but state that it is unclear whether that would alleviate neurological symptoms.

The paper draws attention to the innominate vein as among the veins that can be involved in CCSVI.

The patient's MS manifested very early, at age 13. Could this be because the CCSVI was particularly severe?
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Re: Serbian case study of extrinsic CCSVI

Postby frodo » Wed Jul 04, 2012 11:41 am

I would say that there must be a relationship. As always, you find impressive relationships. Thank you.
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Re: Serbian case study of extrinsic CCSVI

Postby Cece » Thu Jul 05, 2012 1:09 pm

Thanks, frodo. And of course this is just a single case study. We don't have much information about CCSVI in pediatric MS. Sometimes pediatric MS is seen in toddlers and small children. Awful.

I wonder how to define what is severe CCSVI compared to more mild CCSVI. This was bilateral internal jugular stenoses, a compression of one internal jugular, and a compression of the innominate vein into with the jugular drains. And could severity of CCSVI be linked to earlier onset of MS? Unanswered questions.
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Re: Serbian case study of extrinsic CCSVI

Postby 1eye » Fri Jul 06, 2012 5:25 am

The guy who had the car crash, who wrote the book "Rise and Shine", Simon Lewis (also seen on a Ted Talk) had ribs removed to solve what might have been an insufficiency. Could that have been happening to this guy at age 13?
"Try - Just A Little Bit Harder" - Janis Joplin
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Re: Serbian case study of extrinsic CCSVI

Postby Cece » Fri Jul 06, 2012 6:47 am

http://www.sonoworld.com/fetus/page.aspx?id=2950
Image

This was like one of my son's look-and-find books; even though it's labelled, it took me a couple minutes to spot the difference. Do you see in the left image how the right subclavian artery branches off of the right common carotid? But in the right image, the right subclavian artery branches off of the aorta arch, which requires it to run behind the trachea and behind the right carotid artery. And in this patient, that aberrant right subclavian artery smooshed the innominate vein in the process. (Smooshed is the medical term...)

CCSVI is highly variable! ARSA compression of the innominate vein, in combination with the jugular intraluminal stenoses and jugular compression in this patient, is a possible presentation. A question is whether it is treatable and worth treating and how. A stent in the innominate vein should do the trick but would have a risk of migration to the heart.

Compression by ribs could be a different presentation. CCSVI is highly variable. I was glad when I had fairly standard internal jugular valve stenoses, in the usual spot, treated the usual way.
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Re: Serbian case study of extrinsic CCSVI

Postby HappyPoet » Fri Jul 06, 2012 7:09 am

Cece wrote:This is a case of pediatric MS, diagnosed at age 13, treated for CCSVI at age 23. The patient had previously had angioplasty twice, first to the left jugular and then to both jugulars. This time around, the doctors could find no stenoses within the vein, but found two areas of extrinsic compresion.
No intraluminal IJV stenoses were found, but ARSA was verified with a head compression to trachea and esophagus and secondary brachiocephalic vein obstruction. (Fig. 1) Bilateral IJV distal obstruction by first cervical vertebra transverse process was found as well.

Cece, very interesting case!
This is a situation where the Atlas vertebra (C1) was misaligned such that BOTH IJVs were obstructed. This case supports Dr. Flanagan's and others' contention that UCC (upper cervical chiro) diagnostic X-rays should always be part of a CCSVI investigation.
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Re: Serbian case study of extrinsic CCSVI

Postby Cece » Fri Jul 06, 2012 7:23 am

"Bilateral IJV distal obstruction by first cervical vertebra transverse process" means the atlas was big enough or misaligned enough to compress the jugulars on both sides? The obstruction was distal, meaning up by the skull base rather than at the base of the neck. I agree that this is an example of a patient with atlas impinging on the jugulars. We don't know that manipulation of the atlas is successful at moving it off of the jugulars, but I would think it would be worth a try. It's been said before that if there's nothing compressing the other side of the jugular against the atlas, the jugular should just expand as needed in the other direction (away from the atlas) when flow goes through. If there's an indentation, the question is if it's enough to cause reflux or enough to slow down flow.
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