Fwd: [LDN_Users] OFF TOPIC: anatomical stenosis of jugular veins

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Date: Thu, Jul 14, 2011 at 5:59 PM

Subject: [LDN_Users] OFF TOPIC: anatomical stenosis of jugular veins

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Anatomical stenosis of the internal jugular veins : supportive evidence of

chronic cerebrospinal venous insufficiency ?

by Alessandro Rasman<http://www.facebook.com/profile.php?id=100001762281491>on

Thursday, July 14, 2011 at 1:44am

Journal of NEUROLOGY, NEUROSURGERY & PSYCHIATRY with Pratical Neurology

Anatomical stenosis of the internal jugular veins : supportive evidence of

chronic cerebrospinal venous insufficiency ?

Baiocchini, MD Raffaele Toscano, Wilfredo von Lorch and Franca Del

Nonno

National Institute for Infectious Diseases " L. Spallanzani " , Via Portuense

292, 00149 Rome, Italy, +390655170277, Fax +390655170430

We write in relation to the editorial commentary from Khan et Tselis (1)

who rightly suggest caution to consider chronic cerebrospinal venous

insufficiency (CCSVI) as a pathological entity and cast serious doubt on its

relevance to multiple sclerosis (MS); they forecast properly designed

studies to investigate the relevance of CCSVI to MS, in order to carry out

interventional procedures.

The absence of extracranial venous stenosis at the earliest stage of MS

makes it an unlikely cause of the disease (2). The idea of venous congestion

as a possible contributor to the pathogenesis of MS has been discussed for

the past 40 years, but remained widely unappreciated by the scientific

community.

In contrast with other authors, Zamboni et al (3) defined CCSVI as a

vascular condition associated with MS; it is characterized by multiple

intraluminal stenosing malformations of the principal pathways of

extracranial venous drainage, particularly in the internal jugular veins

(IJVs) and the azygous vein (AZY), that restrict the normal outflow of blood

from the brain. In the study of Zamboni et al there was significant

extracranial venous stenosis localised at the principal level of the

cerebrospinal venous segments as detected by selective venography and

anomalies of venous outflow at color Doppler high resolution examination.

The pathological consequences of CCSVI have been hypothesised to emanate

from chronic venous reflux and hypertension leading to increased iron

deposition in the brain and subsequent MS pathology, including inflammation

and neurodegeneration.

Other recent reports found no differences in cerebrospinal venous drainage

using transcranial and extracranial Doppler imaging (4-5). The discrepancies

in the results may be explained with the absence of standardized

internationally accepted criteria for normal Doppler venous flow parameters

(2).

We performed complete post-mortem examination of two patients with MS, died

for different causes. One patient, a 74 year-old-woman, was hospitalized for

acute respiratory illness and died because of bacterial pneumonia; the other

one, a 35 year-old-woman, died for otogenic bacterial meningitis complicated

with internal jugular thrombosis as demonstrated on MR venography.

Postmortem examination demonstrated in both patients a marked stenosis of

left internal jugular vein at the apex of the angle formed by the two heads

of the sternocleidomastoid muscle where the IJV overlie the carotid artery

with ectasia and congestion of the intracranial veins. Venous flow slowing,

caused by the stenosis, had predisposed to IJV thrombosis, histologically

demonstrated in the second case.

Severe inflammatory disease may be a risk factor for deep venous thrombosis

but also chronic cerebrospinal venous insufficiency. We demonstrate, for the

first time as far as we are aware, the presence of anatomical alteration in

the veins of the neck with impaired venous drainage from the central nervous

system in two patients with multiple sclerosis who died from other causes.

We do not know the exact implications in MS pathology and certainly there

is no doubt that this area warrants a great deal more study. Clinical trials

for evaluating new therapeutic agents and other clinical experimental

protocols may be required.

Authors: Baiocchini, MD Raffaele Toscano, Wilfredo von Lorch and

Franca Del Nonno

National Institute for Infectious Diseases " L. Spallanzani " , Via Portuense

292, 00149 Rome, Italy, +390655170277, Fax +390655170430

References

1. Khan O, Tselis A. Chronic cerebrospinal venous insufficiency and

multiple sclerosis: science or science fiction? J Neurol Neurosurg

Psychiatry 2011;82:355.

2. Yamout B, Herlopian A, Issa Z Extracranial venous stenosis is an

unlikely cause of multiple sclerosis Mult Scler 2010 16: 1341-9

3. Zamboni P, Galeotti R, Menegatti E, et al Chronic cerebrospinal venous

insuffiency in patients with multiple sclerosis. J Neurol Neurosurg

Psychiatry 2009;80:392-9.

4. Doepp F, F, Valdueza JM, et al No cerebrocervical venous congestion

in patients with multiple sclerosis. Ann Neurol 2010, 68:173-183.

5. Sundstrom P, Wahlin A, Ambarki K, et al Venous and cerebrospinal fluid

flow in multiple sclerosis: a case-control study. Ann Neurol 2010,

68:255-259.

Conflict of Interest:

None declared

Published 28 April 2011

From:

http://jnnp.bmj.com/content/82/4/355/reply

--

Yvette

Natural Health Consultant, Herbalist, Writer

www.msquill.com