It is quite possible that CCSVI as a phenomenon was first described by German neurologists in 2003-2004. - facebook prikbord

It is quite possible that CCSVI as a phenomenon was first described

by German neurologists in 2003-2004. Here are some articles from 2005

(first published) and following years, the leading researcher was Dr.

Max Nedelmann.

Journal of Neuroimaging, Volume 15, Issue 1, pages 70–75, January 2005

Functional and Morphological Criteria of Internal Jugular Valve Insufficiency as Assessed by Ultrasound
Max Nedelmann MD, B. Martin Eicke MD, Marianne Dieterich M

Abstract
Background and Purpose. Jugular venous valve insufficiency may play a role in different neurological diseases.
This study describes the methodology to detect internal jugular valve
insufficiency and establishes functional and morphological criteria to

discriminate retrograde flow during valve closure from retro grade

insufficiency flow. Methods.
Valve closure was assessed in 100 valves (50 healthy volunteers). The
valves were visualized in B-mode. During a pressure-controlled Valsalva

maneuver, valve closure was monitored by color duplex. The duration and

the peak velocity of retrograde flow were determined. Results. Backward

flow during valve closure in competent valves was visually clearly

discernible from a retrograde flow jet through insufficient valves.

Insufficiency was found in 29% of valves
. The duration of

backward flow in competent valves was between 0.22 and 0.78 seconds

(mean = 0.46 ± 0.14 seconds on Dopp ler measurements) and in

insufficient valves between 1.23 and 6.15 seconds (mean = 2.66 ± 1.28; P

< .0001). Peak velocity of retrograde flow in competent valves was

between 12 and 65 cm/s (mean = 26.2 ± 11.1 cm/s) and between 25 and 160

cm/s (mean = 89.5 ± 39.3 cm/s; P < .0001) in insufficient valves. On

B-mode imaging, the “typical” aspect of an immobile, frozen valve was

seen only in 5 cases of insufficient valves; 21 insuffi cient valves did

not display this aspect.

http://ccsvinews.blogspot.com/2010/12/german-neuros-knew-about-ccsvi-before.html

Conclusion. The dura tion of retrograde flow clearly discriminates
competent and incompetent valves. On the basis of our results, we

provide cut off values that help differentiate between physiological and

insufficiency reflux. The differences in peak velocity and morphology

criteria are helpful but not reliable to predict insufficiency of the

valve.

J Neurol (2005) 252 : 1482–1486
DOI 10.1007/s00415-005-0894-9 ORIGINAL COMMUNICATION

Increased incidence of jugular valve insufficiency in patients with transient global amnesia
Max Nedelmann, B.Martin Eicke, Marianne Dieterich

Results: Valvular insufficiency (either left or rightsided, or
bilateral) was identified in 85% of patients with TGA,and in 45% of

controls (p=0.008).All patients with involuntary Valsalva episodes

immediately prior to TGA developed valvular insufficiency (n=8; p=0.13

compared with patients who did not recall such an event). The mean

duration of the insufficiency jet did not differ significantly between

patients with TGA (3.26s) and controls (2.78s; p=0.315).However,patients

with TGA who experienced a trigger event were characterized by

significantly longer insufficiency reflux times (3.84s) than those

without (2.55s; p=0.03). Conclusions TGA is associated with an increase

in the prevalence of jugular insufficiency.

Valvular insufficiency may lead to increased venous pressure
transmission during a Valsalva maneuver and thus contribute to venous

ischemia in TGA.The association of valvular insufficiency and longer

reflux times with the occurrence of a trigger event further suggests

that cerebral venous congestion is an important etiological factor in

transient global amnesia.

The principal finding of the present study is a significantly increased
prevalence of jugular valve insufficiency in the group of patients with

TGA,compared with that in an age and gender matched control group. These

data support the hypothesis of jugular valve insufficiency as a

predisposing factor for the development of TGA.

In conclusion, our data contribute to an understanding of the etiology
of transient global amnesia. Our findings further confirm the results

reported by other investigators, and support the hypothesis that

cerebral venous hypertension caused by intensive and prolonged Valsalva

strain and facilitated by jugular valve insufficiency – possibly in

combination with additional, yet unidentified contributing factors –

plays a significant role in the pathogenesis of TGA.

Volume 33, Issue 6, Pages 857-862 (June 2007)

Analysis of Internal Jugular Vein Insufficiency—A Comparison of Two Ultrasound Methods
Max Nedelmann, Daniel Teschner, Marianne Dieterich

Abstract

Jugular venous valve insufficiency is a contributing factor to different
pathologic conditions. For assessment of insufficiency, two ultrasound

techniques have been developed, that are based on very different

methodology (direct Doppler assessment versus air contrast ultrasound

venography [ACUV]). This study was conducted to compare these two

methods to improve comparability of existing studies and diagnostic

accuracy in future studies. The function of 40 valves was determined in

20 individuals during a Valsalva maneuver. For direct Doppler

assessment, valvular competence was assessed on basis of Doppler

recordings, following recently established criteria. Valvular

insufficiency in ACUV was diagnosed when reflux of an air-based echo

contrast agent through the valve could be detected. With both methods,

evaluation of 39 valves was accomplished (one exclusion due to

hypoplasia of the corresponding vein). Both methods showed very high

agreement in detection rates. All 18 valves being classified as

insufficient by Doppler criteria were also insufficient in ACUV. Of 21

valves classified as competent (Doppler), one valve was rated as

insufficient in ACUV due to discrete reflux of microbubbles. However,

ACUV was inaccurate in evaluation of the left internal jugular vein

after injection of the contrast agent into the right cubital vein. High

detection rates could only be achieved when this was taken into account.

This study shows that detection rates of internal jugular valve

insufficiency are very similar with both methods. However, this high

agreement required modification of the established protocol of ACUV.

Journal of Neurology

Volume 256, Number 6, 964-969, DOI: 10.1007/s00415-009-5056-z
Original Communication
Venous obstruction and jugular valve insufficiency in idiopathic intracranial hypertension
Max Nedelmann, Manfred Kaps and Wibke Mueller-Forell

Discussion

This study shows that insufficiency of the internal jugular valve is a
frequent finding in patients with IIH. The prevalence of valvular

insufficiency is more than double compared to a control group that was

matched for age, gender and BMI. These results support the hypothesis

that impeded venous return from the brain may play a causal role in the

etiology of IIH.

The finding of internal jugular valve abnormalities is to be seen in
this context, as valvular insufficiency may have facilitated pressure

transmission from the right heart into the intracranial venous system.

Our patients significantly more often displayed functionally and

structurally deviant internal jugular valves as compared to the control

group. In this study, the patient and the control group were carefully

matched for gender, age and BMI, as these factors are known to influence

the frequency of pathological findings at the internal jugular valves

[31]. A slightly higher age of the controls was not significantly

different from the patient group and would, if at all, have influenced

the results towards a higher prevalence of valvular insufficiency in the

control group.

In the context of the discussed literature, there is strong evidence
that venous outflow abnormalities and obstructions are a unifying

mechanism in the development of intracranial hypertension. Intra- and

extracranial obstruction and venous pressure elevation may be

complementary factors. However, it is stressed that the venous

hypothesis has its limitations, as it does not conclusively explain all

distinctive characteristics of IIH.