"In the literature, there have been several re- ports of vaseular malformations that run a long insidious course and simulated multiple sclerosis [Cader and Winer 1999. Honcza- renkoetal. 1995, Stahl etal. 1980, Vrethemet al. 1997].
However, in most published case reports, vaseular malformations were homo- genous and monofoeal.
We would like to demonstrate a case with fluctuating progres- sive neurological deficit and multiple differ- ent vascular malfonnations involving cere- brum, brain stem, cerebellum, spinal cord and spinal roots."
Have you guys seen this??
Search google for this:
(Vascular OR Venous) AND Multiple AND Sclerosis
and lots of interesting reading comes up.
They postulate that Vascular malformations usually develop as a result of influence of teratogenic factor(s) acting in the defined embryonic/fetal period.
This (if true and I know I am getting way ahead, think of this as jamming) would tie in all those factors you are talking about. Loose familial connection, natives getting MS when westerners move in (if they brought with them the tetragenic agent) also, clusters. Also this could be an agent that came in around the time MS exploded and be a foetal development thus congenital weakness caused by tetrogenesis.
Birth defects are known to occur in 3-5% of all newborns. They are the leading cause of infant mortality in the United States, accounting for more than 20% of all infant deaths. Seven to ten percent of all children will require extensive medical care to diagnose or treat a birth defect. And although significant progress has been made in identifying etiologic causes of some birth defects, approximately 65% have no known or identifiable cause.
It was previously believed that the mammalian embryo developed in the impervious uterus of the mother, protected from all extrinsic factors. However, after the thalidomide disaster of the 1960s, it became apparent and more accepted that the developing embryo could be highly vulnerable to certain environmental agents that have negligible or non-toxic effects to adult individuals.
If that is the case as you've argued a lot of times Bob but not I believe for foetal influence of environmental factors (but it makes sense, not dangerous for adults but would be for baby), vascular weakness introduced - develops slow ischemia (MS).
For some its RR for some its right downhill depending on specific patterns of stenosis that Zamboni believes he's identified.
Nothing before has clicked so well into place in my opinion.
We can nit pick about some stats but I believe the evidence is overwhelming and growing daily.