One thing that puzzles me is that (as I read it) azygos *reflux* is seen more often in secondary progressive patients than in relapsing-remittent ones. Azygos *malformations* on the other side are (as I understand) not seen at all by Dr. Dake. This would mean that at least the azygos reflux is not congenital (except for, maybe, in primary progressive people), and caused by something else.
We also observed that the PP course was related to a CCSVI pattern significantly different as compared to RR and SP, suggesting that the location of venous obstruction plays a key role in determining the clinical course. For instance, PP course, characterized by a slowly progressive syndrome with spastic paraparesis and MRI demonstration of MS plaques in the spinal cord, 20,30-32 was significantly associated to obstruction at several levels of the azygous vein and of the lumbar plexuses (type D pattern, Fig. 3, Table III). In this situation venous blood of the spinal cord can be drained only in an upward direction, and is shunted toward the venous plexuses inside the spine (Fig. 3, 4), contributing to explain the correlation between type D and spinal
cord involvement in PP patients.
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