Dr. Dake on "retinal vein sheathing": MS-like lesions, but no myelin
September 16, 2011 at 7:57pm
Dr. Dake made a very important point for the CIRSE conference with his in depth essay on the importance of CCSVI research.
Retinal Vein Sheathing in MS-- The veins of the retina in pwMS become enlarged and thickened and there is damage to the retinal nerves. Without myelin. 99% of the time, there is no myelin on retinal nerves, but there is MS damage.
Here's Dr. Dake---
Underappreciated in the midst of these clashing positions is one other example of a similar venous lesion with potential relevance to MS – sheathing of retinal veins. This cuffing or sheathing of veins can be appreciated on fundoscopic examination of the eyes and may be associated with retinal vein thrombosis, optic neuritis and vision loss.
In the majority of cases when it is diagnosed during an evaluation of disturbed vision, it occurs in patients with MS. Studied extensively at the Mayo Clinic, it is not however singularly associated with cases of established MS. Its frequency among MS patients is estimated to range from 11% to 42%. After fluoroscein dye administration, it is possible to observe leakage of dye around the retinal veins and histologically, the veins display a thickened wall similar to appearances observed in other chronically obstructed venous territories.
When contemplating the possible association between venous obstruction, blood-brain barrier leakage, myelin destruction and immune mechanisms responsible for the initiation of MS, it is interesting to note that the retinal nerve fibres are not myelinated in 99% of the population.
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Lesions due to MS, occuring on nerves that do not have myelin. Leaking veins--in people who develop MS. "Cuffs" that contain immune cells around these leaking veins.
The optic nerve, which exits the back of the eyeball, DOES have myelin. The retinal nerve sheath, inside the eyeball, does not.
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These vascular abnormalities of the eyes in pwMS have been noted by opthamologists for decades.
Here's a paper from 1986
