There also was a lack of enhancement within the distal aspect of the left transverse sinus, left sigmoid sinus, and the origin of the left jugular vein. The findings were highly suggestive of cerebral venous sinus thrombosis (CVT), but there was no evidence of arterial or venous infarct.
A follow-up brain magnetic resonance venogram (MRV) at 1.5 T a few days later showed no flow-related enhancement within the left transverse and sigmoid sinuses, strongly suggestive of CVT (Figure 2). A magnetic resonance arteriogram of the cerebral arteries was normal. At the time of the MRI and MRV, the patient reported no new neurological symptoms—specifically denying headache—and improvement in the left leg weakness.
Our patient's MS is less likely to be responsible for the development of CVT. Except for the possible link with corticosteroid therapy or use of other thrombotic agents, no increased risk of venous thrombosis in association with MS has been reported. Eight patients with MS and CVT have been reported.
THis case says the patients blockage is "strongly suggestive" of CVT....but they DO NOT find the actual source, because they are looking in the wrong place...the brain instead of the jugulars and azygos.
I'd actually read many reports (like this one) of MS patients "suddenly" developing blockage after receiving steroid treatment, because NOW an MRV is warranted and done and the reflux is seen, it becomes linked to the steroids. Of course, no one would see the venous blockage if they do not LOOK FOR IT in the first place! As we now understand, venous blockage and stenosis is present in the beginning of MS, probably a congenital condition. It's manifestation is silent....creating the leak in the blood brain barrier and resultant damage in the brain and spine. But the steroids did not cause it....
Important to note...the actual site of blockage is not seen. These docs look upriver and see a lack of flow and ASSUME CVT (which is cerebral). They do not know to look for stenosis further south.
CVT is presumed and a "story" is made up to explain it. Look at all the studies assuming CVT in MS....there must be 50 patients misdiagnosed. The docs say, It must be steroids...why else would someone with MS have venous blockage?? But the paradigm has been incorrect. I know steroids did not create my husband's stenosis. It is more than just blockage, it is not thrombosis...it is a complete malformation of his jugular veins. And he's had it along time. We just finally found it.