Jugular Veins are Important

Recently published in the Journal of Mutiple Sclerosis, a review paper co-authored by Dr. Paolo Zamboni and Dr. Massimo Pedriali on the "Pathology of the Internal Jugular Vein in Multiple Sclerosis".   The complete paper is available on line for free---and I'd recommend it to all.  It is a very thorough review.

http://www.omicsgroup.org/journals/the-pathology-of-the-internal-jugular-vein-wall-in-multiple-sclerosis-2376-0389-1000160.php?aid=63610

As this review outlines, there are observable and documented differences between the jugular veins of healthy controls, when compared to people with Multiple Sclerosis.  These pathological differences involve the endothelial cells which comprise the veins' lining.  Endothelial cell aptosis (death) and derangement, as seen in MS, changes the ability of the jugular veins to drain.  Valvular and intraluminal abnormalities in the jugular veins of people with MS have hemodynamic implications.  There is a shift in collagen in the jugular veins of people with MS which affects venous compliance.

Veins have received little attention and research, when compared to the study and understanding of arteries.  Certainly, in terms of brain health, the carotid arteries are scanned and studied, and neurology and stroke researchers know that blockages, clots, and impairment in flow can be disastrous to the brain.  There are treatment modalities developed to deal with carotid artery issues---from medications to open surgery, to interventional proceedures.  No one questions the importance of healthy blood flow to the brain.

But the venous system and the removal of fluids from the brain is even more important than previously imagined.

During the past two years, international researchers have described a newly discovered lymphatic drainage system, which has actual draining vessels, and relies on the brain's draining veins.  These vessels take lymph fluid, carrying metabolites, proteins and toxins, out of the brain.  This process is aided by sleep.  This science is brand new.   It has reversed what we once believed was the brain's "immune privilege."
http://ccsviinms.blogspot.com/2015/06/rewrite-textbooks.html

This "stunning discovery" of a lymphatic drainage system relies on the jugular veins.

"Instead of asking, 'How do we study the immune response of the brain?' 'Why do multiple sclerosis patients have the immune attacks?' now we can approach this mechanistically. Because the brain is like every other tissue connected to the peripheral immune system through meningeal lymphatic vessels," said Jonathan Kipnis, PhD, professor in the UVA Department of Neuroscience and director of UVA's Center for Brain Immunology and Glia (BIG). 
http://ccsviinms.blogspot.com/2015/06/a-stunning-discovery.html

The brain is like every other organ in our body---it needs drainage.  Jugular veins are responsible for the exit of blood, cerebrospinal fluid (CSF) and lymph.  Any delays can cause changes to the brain's immune functioning, oxygenation, glucose metabolism and health.  Delays cause neuronal death and inflammation.  Or, what we see in multiple sclerosis.

Dr. Jonathan Kipnis, the discoverer of these lymphatic vessels, will be the keynote speaker at the International Society for Neurovascular Disease.  He will be presenting his research and proposals for studies in MS, alongside Dr. Zamboni and the other members of the ISNVD.

Here's the program.   “How the Extracranial Venous System Influences Neurological Diseases.”

http://isnvd.org/sites/default/files/ISNVD-2016%20meeting%20outline%20program%20guide%209-21-2015.pdf


This is not going away.
jugular veins are important,

Joan



Notice the difference between the top panel---healthy endothelial cells lining the jugular veins in normal controls, compared to the endothelial cells of a person with MS (bottom)

Figure 5: Scanning electronic microscopy. Top panel: regular disposition of the endothelial cells in IJVs of healthy controls, respectively at 800x (right) and 1500x (left). Bottom panel: irregular arrangement of the endothelial cells in the IJV of a MS patient, respectively at 800x (left) and 1500x (right). The cells appear lifted with craters.

Death knells and coffins...

Death knell for CCSVI!---Another nail in the coffin---
Goodbye to all that; a short history of CCSVI---
CCSVI debunked!---The end for CCSVI

If all you read were the headlines, you might think that CCSVI was nothing more than a scourge, a fantasy, a vampiric spector that science has, thankfully, stabbed through the heart and removed forever.
It's over. Move along, people.  Nothing to see here.

But there is much more going on.

This week, a paper published in a neurological journal showed
"severe extracranial venous anomalies that signficantly impaired normal outflow from the brain" occur in some people with MS.
The full paper, in a provisional pdf, can be viewed here for free:
http://www.biomedcentral.com/content/pdf/1471-2377-13-151.pdf

These scientists do not think CCSVI is over.  They're still finding it.

Jeff and I know all about these extracranial venous anomalies that significantly impair the flow of blood from the brain to the heart.

Four and a half years ago, Jeff and I saw that very same problem happening in his body.  We were astounded at the MRV images on the computer screen in his doctor's office, which showed slowed collateral circulation and two malformed, stenotic jugular veins.

I put up an image from his magnetic resonance venography on an MS Forum.

And in doing so, poked a hornet's nest.

You can see in this MRV picture on the left from Stanford, Jeff had no jugular flow on the left side (right on pic), and reduced flow on the right.  This is evidenced by the collateral veins that are lit up like Satan's curly fries.  This is not normal.
What you should see are straight and open jugular veins, that look like drinking straws.  Like the picture on the right.  Can you see the difference???  Well, our doctor saw the difference, and we decided to treat Jeff's venous malformation.



In fact, both of the images were taken at Stanford University, by one of the premiere vascular specialists in the world.  He and his radiology team would later publish a paper on what healthy normal venous MRV looked like, compared to people with MS.  He believes that the kind of collateral circulation and pulsatility found in pwMS could well be damaging to the brain.  Here is one of his papers on this.
http://www.ajnr.org/content/33/8/1615.abstract


When Jeff's jugular veins were opened up, the collaterals went away, his cerebral blood flowed through his jugular veins in a timely manner, no more pulsatility.  And Jeff's brain has healed.  No MS progression.  His gray matter looks normal on MRI.

It's hard not to wonder what would have happened if I had simply taken the research to Stanford, where Jeff was treated, and then gone home to live out our days.  But I was part of an online MS forum, and we'd been sharing information between pwMS and caregivers.  In fact, that was how I first read Dr. Zamboni's published papers.

Maybe the research would have progressed more readily without patient involvement.  Maybe the scientific community would have been more accepting of Dr. Zamboni's research, without the media and patient spotlight.

But I doubt it.
And anyway, there's no going back.
I'm sorry for the way neurologists have used patient advocacy to prevail against the science.... but I'm also not sorry.  Because I got my energetic, brilliant husband back.  And he no longer has heat intolerence, sleep apnea, or crippling fatigue.  No MS progression.  He's still working more than full days, jogging, biking and living.

CCSVI exists.  It impairs blood flow from the brain.  It may not affect everyone with MS, and it may be present in normal people.  It's showing up in other neurological diseases.  There is great debate as to how it should be treated.  Jeff's doctor used stents, others have replaced veins, ballooned, used cutting balloons--others believe lifestyle and exercise may be enough, or antibiotics might help.  There is no agreement on the best course of treatment, and that has created confusion and controversy.

It's also clouded the fact that there are newly discovered and very obvious venous problems related to neurological disease.  

CCSVI exists.
How it is best treated will be debated, but this exploration is not even close to being over.
Joan

New, Independent research from Serbia

September 12, 2011 at 9:10am

A new paper was recently published in Phlebology, Sept. 2011 issue.

Morphological and haemodynamic abnormalities in the jugular veins of patients with multiple sclerosis

D Radak, J Kolar, S Tanaskovic, D Sagic, Z Antonic, A Mitrasinovic, S Babic, D Nenezic and N Ilijevski Vascular Surgery Clinic, Dedinje Cardiovascular Institute, School of Medicine, Belgrade University, Heroja Milana Tepic ́a 1 Street, Belgrade, Serbia

(This study was not conducted by neurologists, nor was it funded with pharmaceutical monies.  These are vascular doctors --This study was partly funded by the Serbian Ministry of Science and Techonological Development – Project No. 41002.)

I have the full paper, and will break down what the researchers discovered.  

First, it is important to note that they only looked at the jugular veins with doppler.  No transcranial doppler, per the Zamboni criteria, and no venography or azygous.  These researchers wanted to see if they could find "morphological and haemodynamic abnormalities" in the jugular veins.  This means they were looking for physical irregularities and flow distubances in pwMS.  Not completely CCSVI, per Dr. Zamboni's definition.

The limitation of our study is that we did not examine the CCSVI prevalence in patients with MS because we did not investigate the intracranial and vertebral veins. The aim of our study was to evaluate morphological and haemodynamic IJV abnormalities in patients with MS and compare it with healthy controls. For morphological and haemodynamic abnormalities assessment of the IJVs, we used some of Zamboni’s criteria and two other parameters (parameters 1 and 2), which in our practice proved to be a good indicator of IJV flow disorder.

--What they were surprised to discover was that the IJV flow was very different in pwMS, and that they could pick this up with doppler ultrasound.

All these might result in IJV haemodynamics changes that could be assessed by non-invasive and cost-effective colour duplex sonography.6 The main finding of this study was to demonstrate a significantly higher prevalence of morphological and Doppler haemodynamics abnormalities in patients with MS in relation to healthy subjects.

Our study showed that 42% of the patients with MS had Doppler haemodynamic evidence of venous flow abnormalities as compared with 8.1% of the healthy controls. These data not only indicate that venous flow abnormalities were significantly associated with the presence of MS but also indicate that it can be seen in the population not suffering from MS, yet the difference remains statistically significant (P , 0.001).

--Also interesting was that they found faulty valves and stenosing lesions in some of the normal controls, but these irregularities didn't affect the blood flow as much as they did in pwMS.

Two new papers from Dr. Chung

October 19, 2010 at 8:11am

For those who have been following this page for a bit, you may remember my references to Dr. Chung in Taiwan who has been studying the jugular veins in relationship to transient global amnesia (TGA) and other neurological disorders.  

Dr. Chung found that in those with internal jugular vein valve problems, or valves that didn't close properly,  there was reflux of blood in their jugulars when they used a "valsalva maneuver"--that means pushing air up against a closed airway, or straining.  The valves opened and this sent blood back up into the brain, and created temporary ischemic (low oxygen) events.  Dr. Chung postulated this is what causes temporary amnesia.   Some activities that create valsalva manuever are coughing, straining, opening up plugged up ears, lifting, and stressful responses. 

Dr. Chung has two new papers out on aging and the jugular veins.  I thought these were important to discuss after the ECTRIMS conference-- in which a researcher from the American University in Beirut stated that CCSVI could not be important in MS, because he only found CCSVI in older or more progressed MS patients.  He and his team found CCSVI in 92% of what he called "late MS" patients---those who had MS 10 years or more.  To anyone who knows MS, 10 years is not "late MS." 

I know many people who have had MS 30 years and more, but let's get on with what Dr. Chung discovered.  Dr. Chung is now measuring venous return in the jugular veins of the "healthy"  elderly.