Cerebral vein thrombosis following prednisone treatment???

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

Cerebral vein thrombosis following prednisone treatment???

Postby sou » Fri May 01, 2009 7:02 am

Hi all.

I have found this case and I wanted to share it with you:

http://www.psychiatrictimes.com/display ... 0168/56831

sou
Shortest joke: "We may not be able to cure MS but we can manage its symptoms."
User avatar
sou
Family Elder
 
Posts: 582
Joined: Sat Dec 20, 2008 4:00 pm
Location: Greece

Advertisement

Postby cheerleader » Fri May 01, 2009 7:30 am

Thanks, sou.

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.
AC
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
User avatar
cheerleader
Family Elder
 
Posts: 5044
Joined: Mon Sep 10, 2007 3:00 pm
Location: southern California

Postby mrhodes40 » Fri May 01, 2009 9:10 am

I agree completely with Cheer. It is a problem of bias and belief and not looking far enough.

Dr Zamboni tests the deep cerebral veins to see if they are refluxing, this sinus is part of that. Somewhere I read that if one side ie jugular is blocked the blood can backflow into the sinus to use the other side....

the sinus is a communicating structure
User avatar
mrhodes40
Family Elder
 
Posts: 2066
Joined: Thu Sep 23, 2004 3:00 pm
Location: USA

Postby sou » Fri May 01, 2009 11:26 am

Hi.

I am glad that I am not the only one to see it the way you do! :-)

Thanks!

sou
Shortest joke: "We may not be able to cure MS but we can manage its symptoms."
User avatar
sou
Family Elder
 
Posts: 582
Joined: Sat Dec 20, 2008 4:00 pm
Location: Greece

Postby cheerleader » Fri May 01, 2009 12:12 pm

sou wrote:Hi.

I am glad that I am not the only one to see it the way you do! :-)

Thanks!

sou


Well, none of us are neurologists, sou :wink:

Notice that the focus of their MRVs is the brain....if they had just looked a bit further into the neck and chest, they might have discovered the cause of the blockage. Imagine treating a patient with an anticoagulant, without even locating and visualizing the blockage. Seems very strange to me, but as I said, not a neuro.
AC
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
User avatar
cheerleader
Family Elder
 
Posts: 5044
Joined: Mon Sep 10, 2007 3:00 pm
Location: southern California

Postby sou » Fri May 01, 2009 5:09 pm

Actually, they did. See figure 2. There is a large vein "missing" at the right hemisphere of the brain. The normal right side would be an accurate mirror image of the left.

What I was thinking about has to do with the cause of the thrombosis. I feel that the relapse he had and the clot had the same cause and had nothing to do with steroids.

sou
Shortest joke: "We may not be able to cure MS but we can manage its symptoms."
User avatar
sou
Family Elder
 
Posts: 582
Joined: Sat Dec 20, 2008 4:00 pm
Location: Greece

Postby cheerleader » Fri May 01, 2009 5:39 pm

Sou...the right side in figure 2 is fine. The vein is not "missing" - just doesn't have a reflux of blood in it. It's the left sinus that is the problem in figure 2...because their is blockage down below it. As Marie said, the sinuses are communicating structures. If they looked below the left sinus, they'd probably see the blockage in the jugular. They just looked at the cranium and called it a day, and blamed it on the steroids.

Not to be a nit-pick...but they never did not find the blockage. This has nothing to do with clots. That's why anticoagulation therapy doesn't stop the MS disease process.
AC
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
User avatar
cheerleader
Family Elder
 
Posts: 5044
Joined: Mon Sep 10, 2007 3:00 pm
Location: southern California

Postby mrhodes40 » Fri May 01, 2009 6:03 pm

sou said
I feel that the relapse he had and the clot had the same cause and had nothing to do with steroids.


I am interested in this idea it seems like it may be true, in a couple of ways; first if you just look at the refluces and altered hemodynamics that is one way for the clot to be caused in that location.

Second if a clot formed there then that too would further alter the hemodynamics in that area causeing sworls and chaotic flow around it
All of it is bad for the adjacent brain tissue, and I too bet that it was the cause of the relapse..........and existed before the prednisone

but I want to add that the initiating event is probably the stenosis further down, just to be clear :wink:
User avatar
mrhodes40
Family Elder
 
Posts: 2066
Joined: Thu Sep 23, 2004 3:00 pm
Location: USA


Return to Chronic Cerebrospinal Venous Insufficiency (CCSVI)

 


  • Related topics
    Replies
    Views
    Last post

Who is online

Users browsing this forum: No registered users


Contact us | Terms of Service