MRV - Azygos

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

MRV - Azygos

Postby sou » Tue May 05, 2009 5:09 am

Hi all.

I have just returned from the MRV exam. I have only had half of it. Azygous system only. I will have the results on Thursday.

The doctor preliminarily and "off-the-record" told me that the azygous system looked just fine, at a very first glance. That's expected due to my RR course, and my relatively slow progression (I turned into a wreck within a weekend!) after 15 years. I really doubt I will be the first person with MS to have no venous issues at all.

I 'll be back on Thursday an I will post the results of the neck.

sou
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Postby mrhodes40 » Tue May 05, 2009 5:39 am

Hi Sou,
They looked at just the azygos and no neck stuff? If they had done that to Cheer's Jeff they'd have seen nothing too. :wink:

My vertebral veins refluxed on doppler and Dr Dake told me he expects my azygos to be plugged up. He told Cheeer that he expects us all to have a different pattern and that perhaps Dr Z's characterizations of the patterns as below would be a little limited in the final analysis, but out of the 65 people Z saw this was the analysis:

Here's the types from Zamboni Dec '08

Normal) Exemplification of normal extracranial venous outflow direction. In
particular, the black arrows depict the drainage of the IJV system into the
SVC, and of the vertebral plexus (Vplex) outward from the spinal cord into the
azygous system (AZY).
• Type A (30%): This pattern is characterized by a steno-obstruction of the
proximal azygous, associated with a closed stenosis of one of the two IJVs
(red crosses). Reflux is always present, under all postural conditions, in
the stenosed IJV (red arrow), with a compensatory controlateral IJV that
appears with an ample CSA. Reflux in the DCVs was detected by the
means of TCCS in 60% of cases. In the azygous vein the reflux has an
effect as far as the lumbar veins, being able to re-enter the caval circle
either through the system of the hemiazygous vein- left renal vein, or by
rising again inside the rachis.
• Type B (38%): This pattern is characterized by significant stenoses of both
IJVs and the proximal azygous (red crosses). Reflux is present in all three
venous segments (red arrows). Cerebral venous outflow for overcoming
the IJVs stenosis re-enters the heart mainly through cervical collateral
circles (Fig. 1b); for the hampered azygous vein outflow, the collateral
circles include again the intra-rachidian pathway (Fig.3), or the system of
the renal-hemiazygous.
• Type C (14%): This pattern is characterized by bilateral stenosis in both
IJVs, with a normal azygous system (red crosses). Reflux (red arrows)
occurs in the IJVs but not in the VVs, with cervical or intracranial collateral
circles that shunt blood towards the superior vena cava or the azygous
vein system, respectively. The resulting overload of the azygous system is
depicted by black bold arrows.
• Type D (18%): In this pattern the azygous system was constantly affected
in various segments (red crosses), resulting in a forced venous drainage
towards the intrarachidian circles in an upward direction (red arrows)
(Fig.3). The vertebral veins appeared to be refluent, and the intracranial
collateral circles seek to gain the IJVs, as confirmed by reflux detection in
DCVs in 90% of cases. At times, the IJVs were also affected (6 cases,
50%), causing an additional obstruction in these patients.


I am sorry you did not get to do it all at once! waiting again... :roll:
bless you sou!
marie[/quote]
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Postby sou » Tue May 05, 2009 6:11 am

Hi Marie.

Thank you for your reply.

My lesion load is mostly in the brain and the cervical spinal cord. I am a relatively tall guy (193cm) and the magnetic field could only scan approximately 40 cm. So it depicted from a little above the kidneys to the very beginning of the neck.

My neck lipoma is above that level. However I am still freaked out, because I might have MS unrelated to CCVI. I would be the first! I realize that these are not reasonable thoughts, but originate from my depressed subconsiousness.

Thanks!

sou
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Postby cheerleader » Tue May 05, 2009 6:43 am

Hi sou...
My Jeff's like you- 6'2" and all brain lesions and one cervical. His azygos was clear. Jugulars, not so good. Sorry you couldn't do it all at once, but hang in there. You are being proactive about your health. It will all make sense-
AC
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby mrhodes40 » Tue May 05, 2009 6:47 am

Hi Sou,
I see, there is a limit.

Your lesion pattern as all brain and spinal cord matches Jeff's pattern too. Perhaps you also have the bilat jugular stenoses as he did.

I was impressed by the fact that dopplers would not have shown Jeff's pattern and only MRV could see it. I felt a real sense of gratitude that Dr Dake took this up and had MRV available so that it could be uncovered that way...for all of us in that should dopplers have been done instead it would have appeared that he "did not have any venous issue".

it is funny to think about but should this be shown to be the cause of MS people will look at the venous system differently, for example if you did not see the stenosis on first pass you'd look harder.......

or see if you had lyme or Gluten ataxia or hughes or something.

If this is proven it will vastly improve diagnosis for people, remembering that in Dr Simka's paper he tested 3 probable MSers and all three had abnormalities in the neck veins.

We will be very interested in your next result!
marie
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Postby cheerleader » Tue May 05, 2009 7:15 am

This might a problem for people getting MRVs where the MR tube isn't long enough to see from the head to the groin...
something to discuss with vascular docs and MR technicians as we go forward. Every facility will have different machines.
Dr. Zamboni did venograms and used radioactive dye and x-ray machines to see the veins of his patients...MRVs are "safer" but have their own issues.
Each time someone is tested, we learn more. Thank you for doing this sou-
AC
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby sou » Tue May 05, 2009 7:55 am

Hi.

My diagnosis was never in doubt. It is a very typical MS, according to 4 different neuros. The location, the size and the time distribution of the lesions as well as other findings (blood test, potentials, visual field) are very definite. It can be nothing else but MS.

Since I have MS, I am so convinced about the vascular issues that even if nothing is found, I would attribute it to diet, LDN and supplements.

Ok. I may not. :-) But I will investigate it further, until the team of Dr Zamboni themselves conclude that I have no vascular issues.

Thanks for listening!

sou
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Postby mrhodes40 » Tue May 05, 2009 8:06 am

But I will investigate it further, until the team of Dr Zamboni themselves conclude that I have no vascular issues.


I was thinking that for you myself-I am glad you said it.

It is wrong to assume that all vascular people everywhere can do this no sweat like it has no learning curve to it at all...everything has a learning curve and part of that is belief that it is "there". Not all vasculr people at this point are going to buy into that. Not saying yours did or did not, just saying in general that will be true for others.

Sou did I remember that you spoke with Dr Zambni and he said he could treat you after the trial?
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Postby sou » Tue May 05, 2009 8:54 am

Hi Marie.

Yes, that is correct. I was told that he would be able to treat non trial participants after it is over, as long as everything would have gone well.

sou
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Postby Sharon » Tue May 05, 2009 1:01 pm

sou -

It is too bad that you were unable to get everything done at one time - but, in time you will have some answers.

Marie -
It is wrong to assume that all vascular people everywhere can do this no sweat like it has no learning curve to it at all...everything has a learning curve and part of that is belief that it is "there".


Dr. Dake told me basically the same thing - that's the reason I am going to Stanford :)

Sharon
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Postby chrishasms » Tue May 05, 2009 2:01 pm

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Last edited by chrishasms on Sun Dec 06, 2009 1:26 pm, edited 1 time in total.
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Postby Sharon » Tue May 05, 2009 2:28 pm

Yes, I am scheduled at Stanford for June 1st -

I was so impressed with Dr. Dake when I spoke with him. Seems to me that since he has been studying this for awhile and with his credentials as a vascular surgeon that I could not go wrong. Like Dr. Dake said, the first step is to get the tests completed and read correctly; the next step is to decide on treatment; then, I can decide if I want to go on with the procedure. Sounds reasonable to me!

I will follow-up with Univ. Hospital at the end of the week.
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Postby mrhodes40 » Tue May 05, 2009 6:06 pm

Let me add that my dopplers, though we found reflux in the vertebral veins, were faxed to Dr Dake he felt they were not done as well as should be. I am grateful to the people who did them at my request based on Zamboni's work; the fact I have them sends me to Sanford, but it may bode poorly for everyone being able to just pop in to their local vascular and get anything helpful in terms of doplers.

Clearly Dr Dake said Jeff's stenoses could not be detected on doppler yet there they are serious blockages both sides that required surgery.

So with that in mind what does it mean if you go to a vascular office, convince them to try this for you, and they say no we see nothing here?

From Dr Simka "Preliminary report on pathologic flow patterns in the internal jugular and vertebral veins of patients with multiple sclerosis" (abstract linked on research thread)

In addition, it should be stated that not all abnormalities, which are found in venographic examination can also be visualized with sonography.

and
Unfortunately, while scanning of internal jugular and vertebral veins has not been difficult for examiner skilled in a routine ultrasound vascular testing, like the assessment of carotid and vertebral arteries, the
transcranial evaluation of cerebral veins has appeared to require special skills and more sophisticated software of the ultrasonographic system used (1,8,11).


I am concerned that it may not be easy to get good evaluation BEFORE the research that is in the pipeline is out for the practitioner to read; I'll say it again if you have read enough about it to believe you SHOULD see it, you are going to try harder to make sure you find it if it is there.

The special thing about Dr Dake is that he has really dug into the research and he is very interested in the model. He sees it as not only possible but probable, therefore he looks for it with all tools available.

I know there are others out there who would be like that: I hope you guys all find them! Wouldn't it be great if there was someone from every state for the conference next September with Dr Zamboni?
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Postby chrishasms » Tue May 05, 2009 6:07 pm

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