Welcome, Dr. Flanagan,
Your arrival is perfect timing! Last week, I offered to create for my PCP and myself a summary of conditions/syndromes after we discussed whether or not MS could be just a collection of these and other conditions/syndromes that are tragically misdiagnosed as MS due to the common denominator of neurological symptoms.
If you could please look over your section (and perhaps other sections if you have the time), I would greatly appreciate corrections/comments. Thank you very much!
SUMMARY OF CONDITIONS/SYNDROMES MISDIAGNOSED AS MS
Multiple Sclerosis
MS = Unknown trigger -> immunological BBB breach -> demyelination/axonal loss -> symptoms/lesions.
Cause: Autoimmunity theory (unproven).
Symptoms: Sensory, motor, optic neuritis (ON), cognitive, psychological.
Testing: McDonald Criteria, MRI, EPs, LP. Clinical diagnosis of exclusion.
Differential diagnosis.
Treatment: Steroids, CRABs, chemo.
T-cells crossing BBB <--- Excellent "real time" video.
Neuromyelitis Optica (Devic's disease). Asian optic-spinal MS is a variant.
NMO = Aquaporin 4 (AQP4) antibodies -> immunological/antibody BBB breach -> demyelination/axonal loss -> transverse myelitis (TM) and ON with few brain lesions.
Cause: Autoimmunity to white matter nervous system protein (AQP4).
Symptoms: Sensory, motor, ON, cognitive, psychological.
Testing: IgG antibody to AQP4 (70% specificity).
Treatment: Corticosteroids, plasmapheresis.
Mayo Clinic - NMO
Chronically Delusive Misidentification Syndrome (named by Dr. Schelling).
CDMS = Increases in venous pressure -> violent venous back-jets via valveless vertebral veins -> immunological BBB breach -> demyelination/axonal loss -> symptoms/lesions.
Causes: Congenital venous malformation, trauma, CCSVI jugular valve ablation.
Symptoms: Sensory, motor, ON, cognitive, psychological.
Testing: US, MRI.
Treatment: Jugular vein ligature, jugular valve regeneration/reconstruction.
Dr. Schelling MS manuscript, Ch. 5 - Lesions
"Instead of speaking of clinically definite multiple sclerosis, it would be more adequate to speak of cases of unexplained neurological troubles in which the clinicians’ respectively neurologists’ diagnostic repertoire has been exhausted." (Dr. Schelling MS manuscript,
Ch. 3 - CDMS)
Chronic Cerebrospinal Venous Insufficiency (named by Dr. Zamboni).
CCSVI = Jugular/azygos stenosis -> reflux -> slow perfusion -> hypoxia -> immunological and red blood cell BBB breach -> iron deposition -> demyelination/axonal loss -> symptoms/lesions.
Cause: Congenital venous malformation.
Symptoms: Fatigue, headache, heat intolerance, ON, tinnitus, brain fog, swelling, TN.
Testing: Doppler US and TC US (flow), MR-venogram (structure), MRI, CT catheter venogram (gold standard), IVUS.
Treatment: Venoplasty, CRABS if helping, stents.
Dr. Zamboni CCSVI study
Chronic Craniocervical Venous Back Pressure (named by Dr. Flanagan).
CCVBP = C1
"Atlas" vertebral misalignment and/or foramen magnum malformation and/or jugular/vertebral vein outlet malformation -> nerve/vein/artery compression -> venous back pressure and/or reduced arterial flow -> venus congestion (edema) and/or reduced arterial oxygen (ischemia) -> immunological BBB breach -> demyelination/axonal loss -> symptoms/lesions.
Causes: Congenital, aging, trauma, poor posture; associated with PD, Alzheimers.
Symptoms: Venous = sensory, motor, ON, cognitive, psychological. Arterial = fatigue, lethargy.
Testing: X-ray, upright MRI, physical exam.
Treatment: Upper cervical correction by
Nucca, Atlas orthogonal, and other chiropractic methods.
Uprightdoctor
Cerebellar Thoracic Outlet Syndrome (TOS named by Dr. Noda, retired).
CTOS =
Upper-body compression of nerves/veins/arteries by bone/muscle -> symptoms.
Causes: Congenital, collar bone trauma; associated with PD.
Symptoms: Chest pain, dizziness, poor balance; and numbness, weakness, and swelling of neck, shoulder, arm, hand.
Testing: X-ray, physical exam.
Treatment: Correctable with surgical resection of 1st rib bone and/or scalene muscles.
Dr. Poblete Silva
May-Thurner Syndrome (named after Drs. May and Thurner).
MTS Lower-body compression of left iliac vein onto spine by right iliac artery -> symptoms.
Cause: Congenital.
Symptoms: Pain, numbness, weakness, spasticity, and swelling of L or R leg, ankle, foot; deep vein thrombosis (DVT - blood clot).
Testing: CT catheter venogram (enter through left femoral vein), MRI.
Treatment: Correctable with endovascular venous stenting or bypass surgery.
Dr. Raju MTS article
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Edit #1 - More info given on CCSVI (10/6/10).
Edit #2 - More info, links given on MTS, formatting (10/6/10).
Edit #3 - More info given on CCVBP (10/9/10).
Edit #4 - More info, links given on MS, formatting (10/9/10).
Edit #5 - Formatting (12/4/10)
Edit #6 - Fixed broken link for MTS "lower-body" compression link
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