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Dr. Robert Fox: Composition of lesions is water. The most important factor is like real estate: location location location

Next up: Dr. Robert Fox "Postmortem assessment of jugular and azygos vein pathology"

Dr. Fox: injected IJV and azygos veins with silicon and removed for analysis. Upper IJVs not extracted.

Dr. Fix: anatomical variation in tri-, bi-, and uni-cuspid IJV valves

Dr. Fox: Valves looked to be normal in function. Hyperplasia sometimes seen (vein narrowings) and abnormal flaps

Dr. Fox: Intraluminal membranes extending 2/3 the way across the vein sometimes found in IJVs

Dr. Fox: intraluminal septum & sheaths found

Dr. Fox: Higher incidence of intravenous abnormalities in MS patients, but no differences in functional abnormalities

Dr. Fox: Number & location of MS lesions determines disability only in early stages of MS, not in progressive forms

Postmortem assessment of jugular and azygos vein pathology (Robert Fox, USA)

The venous changes of chronic cerebrospinal venous insufficiency (CCSVI) are typically assessed by ultrasound
or MRV, but no gross anatomical description of venous outflow in MS has been reported to date. We harvested
bilateral internal jugular (IJV), subclavian, brachiocephalic, and azygous (AZY) veins from 7 deceased MS
patients and 6 non-MS controls. Veins were injected with silicone, dissected en bloc, incised longitudinally to
expose the luminal surface, and fixed. All valves and structural abnormalities were characterized and
photographed using a stereomicroscope. Vein wall stenosis was defined as a >= 50% reduction in crosssectional
area, defined from vein wall circumference and compared to a normal appearing region in the same
vein. A variety of vein abnormalities were identified. The incidence of vein wall stenoses was similar in MS and
controls. Valvular and other intraluminal abnormalities with potential hemodynamic consequences were
identified in 5 of 7 MS patients (7 abnormalities) and in 1 of 6 controls (1 abnormality). These abnormalities
included circumferential membranous structures (1 MS and 1 control), longitudinally-oriented membranous
structures (3 MS), single valve flap replacing IJV valve (2 MS), and enlarged and malpositioned valve leaflets (1
MS). In addition, many minor anatomic variations without expected hemodynamic consequences were
observed similarly in both MS and controls. These included valves with >2 leaflets, the presence of valves in the
AZY, additional (duplicate) normal-appearing IJV valves, and small membranous septa. In conclusion, post
mortem examination of the IJV and AZY veins of MS patients and non-MS controls demonstrated a variety of
structural abnormalities and anatomic variations. Although vein wall stenosis occurred at similar frequency in
MS and non-MS controls, the frequency of intraluminal abnormalities with possible hemodynamic
consequences was higher in MS patients compared to healthy controls. Histologic analysis is underway. These
results provide a pathologic explanation for the intraluminal abnormalities observed in ultrasound studies and
emphasize the importance of detailed intraluminal assessment.