How to prevent further chronic cerebrospinal venous insufficiency in multiple sclerosis misadventures?
Franz Schelling, MD
Gaissau, Austria
dr.franz.schelling@gmail.com
Hector Ferral, MD
NorthShore University HealthSystem, Department of Radiology, Section of Interventional Radiology, Chicago, USA
hectorferral@gmail.com
Sir,
Reading of the Editorial published on Neurology by Bourdette and Cohen, who claimed for ending a therapeutic CCSVI in MS misadventure, we would briefly discuss on how to prevent it.1
Envisaging brain and cord changes that relate to the more central venous changes of CCSVI is the first step. The diagnosis of CCSVI is based upon venous flow reversals, narrowings, and direct or position-dependent signs of venous stasis. The related flow reversals deep in the brain find little attention.2,3
Bedside diagnoses of MS have no concrete identifying features. They rely on cryptogenic neurodysfunctions perchance fitting in with pragmatically convened on patterns of a progression in time. Writing statistics on the co-occurrence of CCSVI with cerebrospinal dysfunctions defined but by numbers and times cannot but breed further misadventures.3
A recent re-evaluation of CCSVI criterion two, the expiratory cerebral venous flow reversal stresses its topical relevance.2
Corresponding pressure surges arise during compressions of extracranial veins in dependence of some hindrance to the venting of pressurized venous blood in direction of the heart and an insufficient venting via collaterals. CCSVI criterion two directly explains the emergence of the vein-specific brain pathology peculiar to MS.4,5
Focusing on the vein-specific MS symptom relationship and further research on the topic will prevent us from ruining the prospects of CCSVI-MS patients desperate for a cure.
References
Bourdette DN, Cohen JA. Venous angioplasty for "CCSVI" in multiple sclerosis: Ending a therapeutic misadventure. Neurology 2014 2014;83:388-9. [Crossref] [Pubmed]
Tromba L, Blasi S, Vestri A, et al. Prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: a blinded sonographic evaluation. Phlebology 2013 Nov 15. [Epub ahead of print]. [Full Text] [Pubmed]
Zamboni P, Menegatti E, Occhionorelli S, Salvi F. The controversy on chronic cerebrospinal venous insufficiency. Veins and Lymphatics 2013;2:e14. [Crossref]
ms-info.net; Epub 2002. Available from:
http://www.ms-info.net/evo/msmanu/1021.html Schelling F. Chronic cerebrospinal venous insufficiency in multiple sclerosis: weighing the findings. Sang Thrombose Vaisseaux 2012;24:394-404. [Abstract]
http://www.pagepressjournals.org/index.php/vl/article/view/vl.2014.4647/4085Multiple Sclerosiswww.ms-info.net