The morphology of endothelial cells at SEM in the IJV of MS patients is certainly the most resounding aspect of the jugular pathology by comparing with control tissue. There is no need of sophisticated techniques to appreciate the difference because morphology speaks for itself.
...
Over the past few years there has been increasing evidence that tight junctions can be attacked and damaged by viruses in order to complete their cycle. Viruses from at least nine different families have been reported to exploit the tight junction proteins [50].
When you see the phrase "tight junctions" think "Blood-Brain Barrier".
The aspects of the valve surface showed in Fig. 6 cannot exclude that intraluminal fibrosis could be a result from a past, resolved inflammatory or thrombotic process that involved the wall of the IJV. From this point of view some authors quite recently hypothesized a post infective origin of CCSVI in course of MS, focused on clamidia pneumofila [46,47].
Straingauge plethysmography showed a faster flow in healthy controls when they pass from supine to upright posture, 2.73ml/sec on average, respect to MS patients who discharged the venous blood through the neck at 1.73ml/sec [51]. Same conclusions were drawn by Doepp et al. measuring flow in the upper part of the neck by the means of echocolorDoppler. The Authors demonstrate a much larger change in blood flow in normal subject compared to MS patients when the subject go from supine to upright position [52]. Veroux et al., by the means of catheter venography, measured a cut-off of 4 sec to separate normal from abnormal contrast dye clearance time, following a standardized injection in the IJV. Almost 80% of MS patients showed a delayed clearance time in at least one IJV [53]. This result was mirrored by Mancini et al by the means of contrast enhanced ultrasound, which demonstrate a significant reduction of clearance time in the IJV of MS patients respect to healthy controls, when injected with standardized contrast micro bubbles [54]. Interestingly these Authors also found a significant inverted correlation between the delayed IJV contrast clearance and the level of disability, since slower flow corresponded to higher expanded disability severity score.
It seems IJV morphology in MS may be why I'm always falling, and
waiting 10 seconds after standing up before trying to move around, may be a very good idea.
Speculation about what causes demyelination...
Oligodendrocyte is particularly vulnerable by reduced perfusion, and speculatively we may hypothesize that demyelination could be related to less efficient mitochondrial activity and myelin synthesis in these specialized cells. This seems to be confirmed by the observation that in early stages axon injury and loss of myelin are documented in the absence of any inflammatory and immune cells infiltration. Only subsequently macrophages migrate to take-up myelin debris, which are powerful chemo-tactic stimuli [63,64]. We believe that the contribution of brain drainage to inflammation, perfusion and CSF flow warrants further research because are all aspects involved in the complex MS pathogenesis, where the contribution of the IJV restricted flow in consequence of the herein described pathology cannot be further neglected.
So are there any questions?
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Not a doctor.
"I'm still here, how 'bout that? I may have lost my lunchbox, but I'm still here." John Cowan Hartford (December 30, 1937 – June 4, 2001)
