Venous angioma of medulla oblongata mimics MS

[Anonymoose]

I wish the full text was free! Does this make anyone else think of the alternate blood flow routes that are present in CCSVI?
http://www.sciencedirect.com/science/ar ... 1982903032

Surgical extirpation of a venous angioma of the medulla oblongata simulating multiple sclerosis
Menachem Sadeh, M.D., ∗, Itzchak Shacked, M.D.†, Z.Harry Rappaport, M.D.†, Rina Tadmor, M.D.‡
a Department of Neurology, Sheba Medical Center, Tel Hashomer, and The Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
b Department of Neurosurgery, Sheba Medical Center, Tel Hashomer, and The Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
c Department of Radiology, Sheba Medical Center, Tel Hashomer, and The Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
Abstract
A case of a venous angioma of the medulla oblongata is presented. The case is unusual in that it had a fluctuating course for over 12 years that mimicked multiple sclerosis. The natural history of this entity is reviewed and early surgical therapy is advocated.
Keywords
venous angioma; brain stem; multiple sclerosis; vascular malformation; medulla oblongata

http://www.nervous-system-diseases.com/ ... gioma.html

A venous angioma is a small abnormal tangle of veins that can occur in the brain. Although not technically normal, some people consider a venous angioma, or venous malformation, a normal variant because it occurs fairly frequently (probably in at least a few percent of all people) and because it is rarely associated with any symptoms, hemorrhage or other problems.
Venous malformations should not be confused with other cerebrovascular malformations such as a cavernous malformation or arteriovenous malformation. These more rare malformations of the blood vessels in the brain are much more likely to bleed and cause significant symptoms.

Occasionally, an angioma can be associated with another malformation, most commonly a cavernous malformation. In these cases the angioma is just incidental and the real pathology of concern is the cavernous malformation, not the angioma.

[Anonymoose]

http://www.ajnr.org/content/15/4/643.short

Posterior fossa venous angiomas with drainage through the brain stem.
T R Damiano, C L Truwit, C F Dowd, D L Symonds, L Portela and J Dreisbach
+ Author Affiliations
Department of Radiology, Fitzsimons Army Medical Center, Aurora, Colo.
Abstract

PURPOSE To describe 11 cases of posterior fossa venous angiomas with drainage through the brain stem.

METHODS Eleven cases of posterior fossa venous angioma with drainage through the brain stem were evaluated using MR. Correlation with known routes of venous drainage for the cerebellum and brain stem is made.

RESULTS Six of the 11 venous angiomas were found in the cerebellum, four in the brain stem; one involved both the cerebellum and brain stem. The cerebellar venous angiomas drained to subependymal veins about the fourth ventricle and dorsal pons. These then connected with an enlarged transmesencephalic or transpontine vein, to drain anteriorly to the anterior pontine veins. The brain stem angiomas had variable drainage depending on location. Evidence of hemorrhage was seen in five cases.

CONCLUSION Cerebellar and brain stem venous angiomas have several potential routes of drainage, including an enlarged vein traversing the pons, midbrain, or medulla. A knowledge of the normal venous anatomy of this region helps to understand the occurrence of these uncommon routes of venous drainage.

Copyright © American Society of Neuroradiology

[Cece]

Although not technically normal, some people consider a venous angioma, or venous malformation, a normal variant because it occurs fairly frequently (probably in at least a few percent of all people) and because it is rarely associated with any symptoms, hemorrhage or other problems.

That concept of "a normal variant" is a debating point in CCSVI. Are our jugular malformations abnormal and warranting treatment, or are they are normal variant and do not warrant treatment? Do they cause symptoms or do they not cause symptoms? You'll get a different answer depending on whom you ask.

Does this make anyone else think of the alternate blood flow routes that are present in CCSVI?

The difference is that these articles are discussing alternate intracranial blood flow routes. In CCSVI, it is the extracranial blood flow routes that are at issue. Intracranial meaning within the skull, extracranial meaning outside of the skull.

[Anonymoose]

Gotchya. But if blockages can cause all those little weird veins to form downstream (is that how it happens?), couldn't the same blockage cause the same phenomenon to occur upstream?

[Cece]

if flow can't get out one way, it has to get out another way, and/or it slows down

have you read much about angiogenesis and collaterals?

With the venous angioma, is the problem that the angioma and the enlarged blood vessels are compressing the areas of the brain, or is there disruption in flow? In the first research posted, why did the symptoms of the angioma fluctuate over so many years, mimicking MS?

It's interesting research, thanks for sharing it.

[Anonymoose]

if flow can't get out one way, it has to get out another way, and/or it slows down

have you read much about angiogenesis and collaterals?

With the venous angioma, is the problem that the angioma and the enlarged blood vessels are compressing the areas of the brain, or is there disruption in flow? In the first research posted, why did the symptoms of the angioma fluctuate over so many years, mimicking MS?

It's interesting research, thanks for sharing it.

I've obviously not read anything about those weird alternate blood flow routes aka collaterals. lol So much to learn. Wouldn't an angioma or tangle of collaterals be pretty obvious on an MRI anyway? I wonder if they don't stop studying the MRI's once they see the telltale MS lesions causing them to miss other things like "normal" neurovascular compressions. It seems they would more likely be missed than a glowing bullseye angioma and would probably cause the same symptoms. Plus, don't they usually give us 2D MRIs? From what I can tell, it's a lot easier to see the vessels and nerves in the 3d MRIs. I wonder If I can get one of those next time. Speaking of MRIs, you wouldn't happen to have before and after CCSVI images, would you? I am sooo curious about what happens to the vessels around the medulla post CCSVI.

I wish the full text about the MS mimicking angioma was available. Teaser abstract. What would cause the angioma to only compress the medulla sometimes?? Diet? Exercise? Stress? BP? Atlas shifts? Fluctuating flow in the ijv/vvs?

Wow...what a rambling post.

[1eye]

Don't know what you mean about "glowing bullseye angiomas". They are not looked for unless they are a known problem, which apparently they're not, since they are said to be "normal". Hughes syndrome and Lyme's are often misdiagnosed as 'MS'. I think 'MS' is a garbage dump of diagnosis when nobody else can explain symptoms. I saw many doctors in the 15 years between my first event and "diagnosis", including 3 neurologists who didn't know, or weren't saying. I think after that long MacDonald criteria can always be counted on, especially if an MRI shows "lesions". I know I never had an MRV. How would anybody be able to tell if I had an angioma?

[Anonymoose]

Well, they look like glowing bullseyes in some cases on google images. Maybe that's just the impressive ones. They caught the angiomas in the second study posted with MRI. <shrug>

Maybe you can bug your neurologist to look for one. I'm going to pester mine about what's happening around my medulla and try to get a 3D MRI. Can't hurt...until he fires me

[Anonymoose]

Here's a paper with a bunch of brainstem vascular malformation cases, many of which were diagnosed as MS. Makes me wonder if this isn't ppms since it can occur without lesions. Anyway, they can't be missing these today, can they? Maybe the MS part of MS is the light stuff and the vascular malformations are the heavy stuff. Seriously, they couldn't miss these today, could they???

No, there isn't something wrong with your eyes. The paste has space issues and I'm not fixing all of that!...just click the link.
http://jnnp.bmj.com/content/52/2/167.full.pdf

Clinicalpresentationsofvascularmalformationsof the brain stem: comparison of angiographically positiveandnegativetypes
MASAMITSU ABE, RAYMOND N KJELLBERG, RAYMOND D ADAMS
FromtheDepartmentsofNeurosurgeryandNeurology,MassachusettsGeneralHospital,Boston,MA, USA
SUMMARY Clinicalandradiographicfeaturesof63patientswithavascularmalformationofthe brainstem are described.On radiologicalgroundstheywere dividedintotwo groups: one with angiographicallyvisiblelesions(AVAVMs),theotherwithlesionsnotseen angiographically,thatis, occult(AOVMs).Inthefirstgroup theinitialclinicalmanifestationwas duetohaemorrhagein20of the33cases andconsistedofa progressiveneurologicaldeficitin12.Inthesecondgroup 29ofthe30 initialypresentedwitha brainstemhaemorrhage.Thelaterwas oftencharacterisedbydevelopment ofsymptoms over two daysor more (16cases),absenceofheadache(48cases)andtendencyto recurrence (20cases).Clinicaldiagnosiswas dificultinmany cases especiallyintheAOVM group. Severalofthepatientswere misdiagnosedas havingmultiplesclerosis.Clinicaldatainconjunction withmagneticresonance imagingwere helpfulindeterminingthenatureoftheselesions.

[Anonymoose]

This might be the guy with the medullary angioma. Details and MRI images at link...
http://www.nejm.org/doi/full/10.1056/NE ... 3203361213