drsclafani wrote:There are many reports of dural sinus and internal jugular vein thrombosis treated by thrombolysis and angioplasty with improvement. However, i do not recall that any that i have read were in patients with MS
Here are some incidences of CVT and MS, I'm not sure if any of them were treated by angioplasty:
8. Vandenberghe N, Debouverie M, Anxionnat R, et al. Cerebral venous thrombosis in four patients with multiple sclerosis. Eur J Neurol. 2003;10:63-66.
9. Malanga GA, Gangemi E. Intracranial venous thrombosis in a patient with multiple sclerosis: a case report and review of contraceptive alternatives in patients with disabilities. Am J Phys Med Rehabil. 1994;73:283-285.
10. Al Bunyan M, Ogunniyi A. Incidental cerebral venous thrombosis in a patient with multiple sclerosis. J Neurol Sci. 1997;149:191-194.
11. Gunal DI, Afsar N, Tuncer N, Aktan S. A case of multiple sclerosis with cerebral venous thrombosis: the role of lumbar puncture and high-dose steroids. Eur Neurol. 2002;47:57-58.
5. Albucher JF, Vuillemin-Azais C, Manelfe C, et al. Cerebral thrombophlebitis in three patients with probable multiple sclerosis: role of lumbar puncture or intravenous corticosteroid treatment. Cerebrovasc Dis. 1999;9:298-303.
6. Stolz E, Klotzsch C, Schlachetzki F, Rahimi A. High-dose corticosteroid treatment is associated with an increased risk of developing cerebral venous thrombosis. Eur Neurol. 2003;49:247-248.
3. Städler C, Vuadens P, Dewarrat A, et al. Cerebral venous thrombosis after lumbar puncture and steroids in two patients with multiple sclerosis [in French]. Rev Neurol (Paris). 2000;156:155-159.
13. Cerebral Venous Thrombosis Following High-Dose Corticosteroid Therapy in a Patient With Relapsing Multiple Sclerosis
November 1, 2007
Contributed by Kenneth M. Sicard, MD, PhD, and Marc Fisher, MD
This is the one I found most interesting, it identifies it as a case of central venous thrombosis (as identified by MRV) in a RR MSer following a course of corticosteroids. They treated it with warfarin.
"The finding of CVT in this case was rather intriguing because it did not present with any of the usual symptoms.1 There was no history of headache, papilledema, seizures, altered level of consciousness, focal neurological deficits, or meningeal signs. Asymptomatic CVT is a well-recognized entity. What makes this case unusual, however, is that our investigation did not reveal features compatible with any of the common causes that are observed in approximately 25% to 35% of cases."
Could this be a case of CCSVI misidentified as a CVT???
Here is how they diagnosed it: "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)." (Or suggestive of CCSVI?) They failed to follow up with a second MRV after the treatment with warfarin.
"A recent study by Stolz and colleagues6 showed that acute CVT developed in 5% of a cohort of 120 patients during intravenous corticosteroid treatment for relapse of a definite MS. Strikingly, this rate is as high as that expected in protein C or S deficiency."
The link:
http://www.psychiatrictimes.com/display ... 0168/56831
If corticosteroids increase the chance of CVT and retrograde flow increases the chance of CVT, then that strengthens the argument that we should be treated?