Welcome! This blog contains research & information on lifestyle, nutrition and health for those with MS, as well as continuing information on the understanding of CCSVI and cerebral hypoperfusion. This blog is informative only--all medical decisions should be discussed with your own physicians.

The posts are searchable---simply type in your topic of interest in the search box at the top left.

Almost all of MS research is initiated and funded by pharmaceutical companies. This maintains the EAE mouse model and the immune paradigm of MS, and continues the 20 billion dollar a year MS treatment industry. But as we learn more about slowed blood flow, gray matter atrophy, and environmental links to MS progression and disability--all things the current drugs do not address--we're discovering more about how to help those with MS.

To learn how this journey began, read my first post from August, 2009. Be well! Joan

Friday, September 20, 2013

The Central Vein Sign and New Research


September 20, 2013

It was 150 years ago, in 1863, when Eduard von Rindfleisch first peered through his microscope at an MS lesion and noted a vein inside the cerebral MS lesion.

If one looks carefully at freshly altered parts of the white matter ...one perceives already with the naked eye a red point or line in the middle of each individual focus,.. the lumen of a small vessel engorged with blood...All this leads us to search for the primary cause of the disease in an alteration of individual vessels and their ramifications; All vessels running inside the foci, but also those which traverse the immediately surrounding but still intact parenchyma are in a state characteristic of chronic inflammation. 

Rindfleisch E. - "Histologisches detail zu der grauen degeneration von gehirn und ruckenmark". Archives of Pathological Anatomy and Physiology. 1863;26:474–483.

We've known for over a century that MS lesions are perivenous, meaning lesions form around a vein.  There is a vein in the center of almost every cerebral MS lesion, and this makes the MS lesion unique.

So, it was interesting to see THREE brand new papers on this topic in 2013, coming from neurological research. 

Here's one from July 2013, published in "Frontiers of Neurology"--suggesting that these central veins and perivenous lesions, which are now very clear on 7Tesla MRI, might be helpful in making an MS diagnosis.

Venocentric Lesions: an MRI marker in MS?
In the past decade, numerous studies have explored a promising biomarker for MS: MRI-detectable veins within lesions. This biomarker is well established as detectable at 3 and 7T and efforts should be made to identify/optimize clinically practical methods for its evaluation. Prospective studies have shown that the presence of venocentric lesions at an early but ambiguous clinical presentation is highly predictive of future MS diagnosis. Work remains to be done to confirm or exclude lesions of common MS mimics as venocentric. Common imaging practice and lesion-rating paradigms should be adopted by scientists working in this field.

Here's another paper entitled "The Central Vein Sign: is there a place for susceptibility weighted imaging in possible multiple sclerosis." (Readers of this page know that CCSVI investigator, Dr. Mark Haacke, is the inventor of SWI.  He has noted these central veins and iron deposition in the MS brain for almost a decade now, and linked their presence to CCSVI.)

Susceptibility weighted imaging (SWI) may have the potential to depict the perivenous extent of white matter lesions (WMLs) in multiple sclerosis (MS). We aimed to assess the discriminatory value of the "central vein sign" (CVS).

The "central vein sign" was predominantly seen in MS lesions. The "central vein sign" helps discriminate between MS and non-MS lesions.

Here's yet another study published in the Journal of Neuroimmunology in May 2013 which notes the central veins visible in MS lesion.

Of the 29 patients enrolled and scanned using 7-T MRI, so far 22 have received a clinical diagnosis. All 13 patients whose condition was eventually diagnosed as MS had central veins visible in the majority of brain lesions at baseline. All 9 patients whose condition was eventually not diagnosed as MS had central veins visible in a minority of lesions.
In our study, T2*-weighted 7-T MRI had 100% positive and negative predictive value for the diagnosis of MS. Clinical application of this technique could improve existing diagnostic algorithms
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These papers are no surprise--researchers have been noting these veins inside MS lesions for over a century.  But what continues to shock me is that researchers aren't asking WHY?




Rindfleisch, with his microscope in 1863, was wondering why there was a change in the blood vessels in the MS brain.

Here is Dr. C.W. Adams in 1987, looking at autopsied brain tissue in the hopes of understanding the mechanism of lesion formation in MS.

The periventricular region was studied in the brains of 129 cases of multiple sclerosis, with the purpose of establishing the mechanism and order of events in the development of the periventricular plaque, and deciding whether there is any relationship between granular ependymitis and such plaques. Periventricular plaques were found in 82.2% of cases. Observation and computerized morphology showed that the early stage of the periventricular plaque is the formation of a lesion around a subependymal vein and that adjacent lesions later coalesce
(Subependymal means below the ependymal zone, in the lateral ventricles of the brain.)



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One cardiovascular doctor has asked why, and utilized Dr. Zamboni's research to explain the central vein found in MS lesions.

Here's Dr. Michael Dake's illuminating powerpoint presentation, explaining how CCSVI would create vessel wall breakdown, due to disturbed venous blood flow, microbleeds and perivenous fibrin cuffs, activating the inflammatory process. This would lead to adhesion molecule and cytokine expression, oxidative stress and reduced NOS activity--endothelial dysfunction and a breech in the blood brain barrier.  We know how this happens in chronic venous disease in other parts of the body.  Laminar, or smooth blood flow, maintains the endothelium.  Disturbed blood flow leads to a break down.
This would explain the central vein inside the lesion.



Perhaps neurologists do not want to ask why there is a central vein; because they know the answer points to a vascular connection to multiple sclerosis.  Their studies are looking at this central vein in MS lesions as purely a means to aid MS diagnosis, so they might begin disease modifying medications in their patients.  

But the looming question remains....why the central vein?
The answer will provide healing for those with MS.

Joan

PS--for those who wish to learn more about this history, Dr. Schelling has written the most comprehensive and thorough evaluation of the history of MS lesion studies.

7 comments:

  1. Hi,

    I was hoping to get in touch with you about your blog. My wife is a cancer survivor and I was wondering if I could ask you a quick question. Do you think you could email me when you get a chance? Thanks so much.

    Cameron

    cameronvsj(at)gmail.com

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  2. Hi Cameron--I'm not a doctor, and certainly no expert in cancer (or really anything :) I have written about how cancer drugs and chemotherapies might affect the vascular systems in those with MS treated with these medications. I don't really feel comfortable e-mailing or answering specific medical questions....but here's the note I wrote on the topic of chemo. Best to you and your wife. https://www.facebook.com/notes/ccsvi-in-multiple-sclerosis/chemotherapy-ms-drugs-and-your-vascular-health-what-you-need-to-know/10150174254902211

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  3. Thank you always from me here in LEICESTER UK .

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  4. After having MS for 44 years and taken NO MS meds ever I am 100% proof of whats really going on here in the UK and very badly trolled online for speaking up for myself .

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  5. I have also had so many so nasty towards me even after I nearly died in 2010 after having bladder botox given to me at the time it was not clinically trialled yet still given to me. Fitted with a male catheter after ! as they has ran out of female ones and then had to move into a disabled bungalow 2 weeks later in UK I have been so badly treated , yet many musicians and stars from UK have done so much for me even those have met and chatted too.I am very proud of all our ENGLAND footballers who sent me a signed shirt and letter to me the same year we all worldwide celebrated 150 years of CCSVI like they did in football in 2013 .

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  6. Even on this you tube channel have had disabled hate towards me have spoken up about also .My lists are endless of whats been said to me on the net.https://youtu.be/jdaq-Ecz7Co

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    1. I'm so sorry to read about the abuse and bad treatment, Lynne...you truly deserve better! Know that no one can take away the knowledge and means of self care you have found for yourself---whether or not they choose to believe it. As my Mom likes to say, "you can lead a horse to water, but you can't make it drink!" You can share this info, and if folks don't want it to believe it, that's their right. But it's your right to keep learning and sharing. Be well!!!! xoxo

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