Welcome! This blog contains research & information on lifestyle, nutrition and health for those with MS, as well as continuing information on the understanding of the endothelium and heart-brain connection. 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 auto-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

Tuesday, May 30, 2017

Jugular anomalies and collateral flow in multiple sclerosis

There is a new paper recently published in the American Journal of Radiology from Dr. Haacke's superb radiology team at Wayne State University in Detroit, called Jugular Anomalies in Multiple Sclerosis are Associated with Increased Collateral Venous Flow

The complete paper is here:  link

As many of my readers know, there has been very little study of the outgoing venous system, especially when compared to the ingoing arterial side of blood flow.  We have a well-documented understanding of how problems with carotid arteries, the main inflowing blood vessels to the brain, can cause disease.  link  There are many papers on carotid arterial stenosis and stroke, dementia, Alzheimer's and other diseases of neurodegeneration.  And carotid artery scans are quite commonplace.  Angioplasty treatment for carotid arterial disease is an accepted and even routine practice today.

But in contrast, the venous system, specifically the internal jugular veins which are the main drainage route for the brain, has been under-researched and is not well understood.  A common thought from doctors has been that the brain can utilize collateral veins to drain, and that when the jugular veins are blocked, it's no big deal, since there are other veins to take up the flow.  This paper is one of the first which is looking specifically at how blockage of the IJV changes venous flow patterns.

Research on venous abnormalities in MS thus far has been limited to the IJV, and little is known about extracranial venous collateralization. The extrajugular drainage system consists of the vertebral venous system; the deep cervical veins, which anatomically are paraspinal toward the heart; and the anterior and external jugular veins, which receive blood from facial and superficial areas.8 Although the presence and structure of collateral veins have been assessed by using time-resolved imaging of contrast kinetics venography, flow values were not quantitatively evaluated.9-11 The purpose of this work was to examine the relation of extracranial venous anatomy and flow in a large cohort of patients with MS and healthy controls (HCs) taken from our neuroimaging data base.12 Because of the complexity of the extracranial venous system, we have classified these vessels into 3 groups based on anatomic MR information and their drainage path: primary (ie, IJV), paraspinal, and superficial. We hypothesized that increased venous paraspinal and superficial flow will also be observed for cases that evidence abnormal IJV structure and flow. In contrast, a subset of patients with MS may have a distinct collateral venous flow pattern compared with patients with MS and HCs without structural venous anomalies. 

In a study of 153 people with MS, 55% of the MS group exhibited jugular venous stenosis.  In the healthy control group of 105 people, 20% had stenotic veins.  Both of these groups had collateral venous flow, either through the vertebral or paraspinal veins.   The anatomic assessment of these vessels really isn't the complete picture.  Remember Dr. Zamboni's quote--"It's not the architecture, it's the flow."

Collateral flow has hemodynamic consequences.   This collateral system is like taking a winding country road when the main highway is blocked.  It is slower, less direct and has consequences for the brain, including venous hypertension and venous insufficiency.  There will be further research on the hemodynamic consequences of collateral venous flow.

One of the leading researchers publishing on this link is ISNVD member Professor Clive Beggs.

Professor Beggs has been able to show that MS is associated with changes in the dynamics of the CSF pulse in the cranium, and that the normal relationship between this and the jugular veins is profoundly altered in MS patients. He has also found that venous drainage anomalies in patients with Alzheimer's disease are associated with blood retention in the cerebral veins, suggesting that constricted venous outflow might be a generic phenomenon implicated in the pathophysiology of other neurological diseases.   Professor Beggs said: “My work suggests that vascular anomalies can profoundly alter the biomechanics of the intracranial space. This is important because there is a growing body of evidence that altered haemodynamics in the cranium are associated with a wide range of neurological conditions.  link
I know it has been frustrating for those waiting for CCSVI science to come in.  In the ten years since Dr. Zamboni first published his initial papers on CCSVI, we have seen an unprecedented pushback from the neurological community to even consider venous flow and the brain.

But we have also seen new publications like this one from radiologists,  and contributions from groups like the Nedergaard Lab, the Kipnis Lab, the Gladstone Lab and the ISNVD.  These groups are publishing on the newly discovered lymphatic system, which relies on the venous system of the brain.  We are now seeing how absolutely vital the brain's veins are--and how problems in venous flow are linked to all diseases of neurodegeneration.  This is real, and the science is coming in.  link

For those who are "out of wait" and frustrated by the pace of this research--it is best to consider the vascular connection to MS and live your most  endothelially healthy life today.  Talk to your own doctor about eating whole, colorful natural foods, exercising or physical therapy, getting UV ray exposure,  increasing quality sleep, reducing stress,  and finding joy and community.  Maybe consider NUCCA or atlas orthogonal treatments, having your venous system scanned for irregularities and getting treatment from a respected IR.

Be hopeful, and be well.

My husband's MRV from Stanford University, April 2009
Showing 99% and 70% obstructed IJVs and collateral flow (those curly, small veins) before his venoplasty treatment


  1. Thank you Joan from me here in the UK .

  2. Thank you Joan for not letting the "True" research being debunked! Your writings are of great importance and easy to comprehend. Too bad the nay Sayers are in big Pharmas pockets, show their ignorance and disdain.

  3. Thank you for continuing to fight for us.

  4. Cara Joan,finalmente parlare di alimentazione sana, migliore qualità delSonno-Sogni o riprendere a sognare, : ...Per coloro che sono "fuori wait" e frustrati dal ritmo di questa ricerca - è meglio prendere in considerazione il collegamento vascolare a MS e vivere la vostra vita più sana endothelially oggi. Parlare con il proprio medico curante di mangiare insieme, alimenti naturali colorati, l'esercizio o la terapia fisica, ottenere l'esposizione ai raggi UV, aumentando la qualità del sonno, riducendo lo stress e trovare la gioia e la comunità. Forse considerare NUČČA o atlante trattamenti ortogonali, avere il vostro sistema venoso sottoposto a scansione per le irregolarità e ottenere il trattamento da un IR rispettato. " e, miglioramento apparato digerente, costipazione-stipsi-stitichezza,minor fatica cronica,minori spasmi muscolari,minori ricadute,migliore memoria-mente,minore stress o statod'ansia giornaliero, miglioramento generale neltempo che losi ottiene,con l'utilizzo della " mia bevanda alcalina osso seppia " presente su motore di ricerca di Google,e ripristino miglioramento delle cellule endoteliali,interno vene,con utilizzo di Ginkgo Biloba,giallooro e possibilmente, non verde,come in commercio,semi di Lino o chia germogliati, olio di oliva EVO ,ma giallo oro denso vivo al frantoio,da olive nere mature,mesocarpo viola fino al nocciolo, 200-250 ml al dì,riscaldato a bagnomaria con succo di limone giallo maturo, per disinfiammare in toto tutto l'apparato digerente, aumentando anche Elastina-collagene e, regolarizzare gli spasmi intestinali, eliminare grastrite, reflusso esofageo,ernia iatale e tutte le ernie inquinali e diverticoli,in minimo 4 mesi di utilizzo e nel tempo, anche le ulcere !!

  5. Hi Joan, I can't find a way to message you so I will leave a comment. I got the CCSVI procedure in early 2011. I saw Dr Dake in 2010 and got confirmation of my venous drainage issue. I am doing great and would love to get a follow up done if it would help research. Please let me know how to get back in touch if that is an option.

    1. Hi Johanna--I'd suggest getting back in contact with Dr. Dake, to see if he'd be able to scan you out again. He can keep track of your MRIs & MRVs, and make comparisons with pre-treatment and now. (Hoping he'll write up a paper some day, as Jeff is out 8 1/2 yrs with gray matter atrophy reversal and no MS progression) Apart from that, my best advice is to keep moving, get sunshine, eat well, work with your own doctors to keep tabs on inflammation and monitor gray matter health. So glad you are doing well! That is the best news. stay well, Joan