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Chronic Cerebrospinal Venous Insufficiency: Case–Control Neurosonography Results Andrew D. Barreto, MD,1 Staley A. Brod, MD,1 Thanh-Tung Bui, MD, RVT,1 James R. Jemelka, MA,1 Larry A. Kramer, MD,2 Kelly Ton, BS,1 Alan M. Cohen, MD,2 John W. Lindsey, MD,1 Flavia Nelson, MD,1 Ponnada A. Narayana, PhD,2 and Jerry S. Wolinsky, MD1 Objective: Chronic cerebrospinal venous insufficiency (CCSVI) has been implicated in the pathophysiology of multiple sclerosis (MS). We sought to determine whether neurosonography (NS) provides reliable information on cerebral venous outflow patterns specific to MS. Methods: This was a single-center, prospective case–control study of volunteer MS and non-MS participants. A neurosonologist, blind to the subjects’ diagnosis, used high-resolution B-mode imaging with color and spectral Doppler to systematically investigate, capture, and record extracranial and intracranial venous drainage. These neuroimaging results were evaluated and scored by an expert blinded to subjects’ information and with no interactions with the participants. Results: Altogether, 276 subjects were studied: 206 with MS and 70 non-MS. MS patients were older than non-MS subjects (48.369.9 vs 44.3611.8 years, p<0.007), with durations from first symptoms and diagnosis of 13.7610 and 9.967.8 years, and Expanded Disability Status Scale of 2.662.0. Overall, 82 subjects (29.7%) fulfilled 1 of 5 NS criteria proposed for CCSVI; 13 (4.7%) fulfilled 2 criteria required for diagnosis, and none fulfilled >2 criteria. The distribution of subjects with 0, 1, or 2 criteria did not differ significantly across all diagnostic groupings, between MS and non-MS subjects, or within MS subgroups. CCSVI was present in 7.14% of non-MS and 3.88% of MS patients...
ORIGINAL RESEARCH R. Zivadinov G. Cutter K. Marr M. Ramanathan R.H.B. Benedict N. Bergsland C. Morgan E. Carl D. Hojnacki E.A. Yeh L. Willis M. Cherneva C. Kennedy M.G. Dwyer B. Weinstock-Guttman No Association Between Conventional Brain MR Imaging and Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis BACKGROUND AND PURPOSE: CCSVI has been reported to occur at high frequency in MS. Its signif- icance in relation to MR imaging parameters also needs to be determined, both in patients with MS and HCs. Therefore, this study determined the associations of CCSVI and conventional MR imaging outcomes in patients with MS and in HCs. MATERIALS AND METHODS: T2, T1, and gadolinium lesion number, LV, and brain atrophy were assessed on 3T MR imaging in 301 subjects, of whom 162 had RRMS, 66 had secondary-progressive MS subtype, and 73 were HCs. CCSVI was assessed using extracranial and transcranial Doppler evaluation. The MR imaging measure differences were explored with 27 borderline cases for CCSVI, added to both the negative and positive CCSVI groups to assess sensitivity of the results of these cases.
Chronic cerebrospinal venous insufficiency and multiple sclerosis Insuficiência venosa cérebro-espinhal crônica e esclerose múltipla Emerson Leandro Gasparetto 1, Claudia da Costa Leite 2 In a previous issue of Radiologia Brasileira, Radu & Gonçalves(1) published an editorial discussing the relation between chronic cerebrospinal insufficiency and multiple sclerosis, on the basis of articles published by Zamboni et al.(2,3). Such question has recently emerged and has been fervorously discussed in the scientific community, but definite conclusions are still to be drawn. Thus, as members of the editorial board of this journal, we are concerned about the conclusion of the mentioned article that says: “angioplasty seems a promising avenue mainly for the relapsing remitting multiple sclerosis course, offering significant improvement in long-term neurological outcome with no relapses in patients with stable venous patency”(1). So, we would like to bring forward more information on this subject to the readers of RB, particularly with the objective of emphasizing that, in the literature, there is not any reliable, proved and validated evidence that angioplasty presents any benefit for patients with multiple sclerosis. It should be emphasized that, according to a recent article published in the journal Nature(4), the initial study developed by Dr. Zamboni was a non-randomized, non-blinded trial based on a small series including only 65 patients. Thus, in spite of the findings of such study deserving attention and further investigation, nobody in the clinical community involved in treatment of multiple sclerosis has accepted venoplasty.
Chronic cerebrospinal venous insufficiency Have we found the cause and cure of MS? Robert J. Fox, MD Alex Rae-Grant, MD Address correspondence and reprint requests to Dr. Robert J. Fox, 9500 Euclid Avenue, Cleveland Clinic Foundation, Cleveland, OH 44195 firstname.lastname@example.org Neurology® 2011;77:1 Multiple sclerosis (MS) has traditionally been considered an autoimmune disorder—an abnormal immune system attacking an otherwise healthy brain, spinal cord, or optic nerve. But even in its original description by Charcot, the perivenular predilection of MS lesions suggested a potential vascular etiology. In 1935, Tracy Putman1 reported an animal model of MS based on injecting obstructing agents into the venous sinuses. On the basis of this model he treated 74 patients with MS with the anticoagulant dicumarol, with mixed results.2 After lying dormant for over half a century, the vascular theory of MS re-emerged with a series of publications led by the Italian vascular surgeon Paolo Zamboni. He used ultrasound and catheter-based venography to describe venous insufficiency in the internal jugular veins (IJV), vertebral veins, and deep cerebral veins of patients with MS, coining the term chronic cerebrospinal venous insufficiency (CCSVI).3 Five ultrasound criteria were proposed (figure), although these have yet to be validated against a criterion standard. Using these criteria, Zamboni and colleagues reported a surprisingly high 100% sensitivity and 100% specificity in discriminating patients with MS from controls. The same group reported clinical improvements in an open-label study of catheter-based venoplasty,4 later provocatively named the liberation procedure. The public response to these reports was profound.5 Web sites, blogs, Facebook pages, and other...
The possible role of the venous system in the pathogenesis of chronic neurodegenerative diseases has been hypothesized for decades. Quite recently, the description of a venous condition deﬁned as chronic cerebrospinal venous insufﬁciency (CCSVI) and its strong association with multiple sclerosis (MS) has brought back the attention of the scientiﬁc community to the hypothesis of an aetiological or concomitant role of an altered venous function in the occurrence of this pathology. CCSVI is identiﬁed by sonographic criteria, thus the indication for its possible treatment is based on ultrasound ﬁndings. Method: We retrospectively examined 167 consecutive patients affected by clinically deﬁned MS and CCSVI, identiﬁed by ultrasound assessment by the presence of at least two sonographic criteria. Ultrasonographic diagnosis of CCSVI was then integrated by venography and intravascular ultrasound examination (in 43 patients). Patients were all submitted to endovascular procedure (venoplasty). Results: In 37% of cases there was no correspondence between the preoperative ultrasound assessment and the venographic ﬁndings. In the event of incongruity between venography and sonography, the intravascular ultrasound examination investigation, when performed, conﬁrmed ultrasound ﬁndings in 42% of cases and venography results in 58%. At one month in 12% of cases ultrasound assessment showed the persistence of altered ﬂux. In 67% of cases patients reported subjective amelioration, regarding non-speciﬁc symptoms. Conclusion: The pathophysiology of CCSVI is yet to be deﬁned. The superior cava venous...
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Many people forget that in March 1991 a referendum was held in 9 of the 15 Soviet Republics and over 70% of the people voted for maintaining the Union and the results were 82% in Belarus, Kazakhstan even at 92%voted in favour of maintaining the USSR.Of course the ''traitors'' and sold out Puppets à la Gorbatchew, Yeltsin & Co didn't take the popular vote into account and went out to sell out the Union .