2008-ban dr. Zamboni Olaszországban felfedezte, hogy az SM betegek nagy részének (60-90%) egyes nyaki, gerinc menti vénái el vannak záródva vagy szűkültek. A betegséget CCSVI-nek nevezte el (chronic cerebrospinal venous insufficiency, krónikus központi idegrendszeri vénás elégtelenség).
Én megjártam a "hadak útját". Alávetettem magam a venográfiának és ballonos értágításnak, azaz a CCSVI-nak Szófiában.SM tünetek:- PPSM - es vagyok. Egy könyökmankóval igen nehezen megyek, a bal oldalam végig félig béna. Továbbá: zsibbadás, izomgörcsök, inkontinancia, fáradékonyság.CCSVI Vizsgálatok:- Nem kimondottan CCSVI - re vizsgáltak itthon, - mert elzárkóztak az orvosok előle - de csináltak már itthon is ultrahangot, nem találtak semmit.- szófiában 3 x (háromszor), 3 különböző (kardiológusok) orvos csináltak ultrahangot, semmi! meg festett CT vizsgálatot is, semmit nem találtak!- Csak a venográffal hátul, bal oldalon a nyakamban.CCSVI műtét:- a műtét 1 óráig tartott az előkészületekkel, keresgéléssel, ballonozással együtt. Stentet nem akartam, már az elején ezt kijelentettem. Teljesen éberen, a monitoron nyomonkövetve "élveztem" az eseményeket. Do'nt worry mondá a doki, Be happy válaszoltam a műtét közben, így zajlott.- a műtét után elég vacakul éreztem magam, kis seblázam volt.Műtét után:- a javulási tüneteket másnap kezdtem érezni. Most még itt van egy hatalmas véraláfutásos folt a combomon, (mert ágyéknál volt a behatolás) de nem vészes.- 6 nappal a beavatkozás után): a fáradékonyságom szinte megszűnt, a fejemet tisztának érzem (ami eddig föl se tűnt, h. mindig kábultnak éreztem), a nyakamat jobbra - balra tökéletesen tudom forgatni (eddig ezzel is baj volt). Hát ennyi.Még várom a további javulást. De ha csak ennyi akkor is nagyon örülök. Nagyon hálás vagyok Istennek és a jóakaróimnak, hogy vállalták a költséget, mert 1,3 millióba került a két kísérőm szállásköltségével, oda-visszautazással (autó), kajával együtt.
A Bulgáriában kapott zárójelentés:
Final diagnosis:
Multiple Sclerosis cerebral-spinal form , and chronic cerebral-spinal venous insufficiency (CCSVI)
Concurrent diseases: Multiple Sclerosis cerebral-spinal form, primary progressive form, EDSS 6.0
Procedure: Percutaneous Transluminal Angiography(PTA) balloon dilation of the left v. jugulars int.sin was performed
Anamnesis:
Concurrent Diseases: Patient was diagnosed with MS approximately 15 years ago, Multiple Sclerosis cerebral-spinal form, primary progressive form, EDSS 6.0
The patient was admitted to our hospital for diagnostic clarification of CCSVI status, and eventual treatment
Family health history risk factors: none reported
Indications for hospitalization:
Diagnostic examinations to assess CCVI status, and to perform angioplasty treatment for MS and CCVI
Objective health condition:
The patient's overall health condition corresponds with age, and is in good overall health. The skin and visible mucosa appear normal- pale pink.
The head and neck anatomy: normal morphology without any cervical vascular occlusions.
No signs of inflammation or swelling of the peripheral lymph nodes and/or the thyroid gland.
Respiratory system: symmetric chest structure, clear sonorous percussion tone, clear vesicular breathing bilaterally.
Cardiovascular system: Resting heart rate 75 bpm, arterial blood pressure120/80mmHg, clear cardiac tones, without murmurs.
Abdomen: at the chest level the abdomen was pliable with no pain
Echocardiography:
Aortic root- 26m; Left Atrium (LA) diameter 31mm, LA area 13 cm2, Right Atrium area 10 cm2, Left Ventricle (LV) without segmental disruptions and normal kinetics, IVS/PWLV- 8/7 mm, EDD/ESD 38/24mm; EDV/ESV 16/12ml; EF 68%; Valve system: aortic valve tricuspid, without regurgitation, Mitral valve VE- 0.9l m/sec,VA- 0.77 m/sec; E/A- 1.18; DT-235; tricuspid valve- without regurgitation; Pericardium- without abnormalities.
Conclusions: 1. Normal Left Ventricle Volume and dimensions. 2. Preserved systolic function, 3. Functionally intact valve system. 3. Right chambers and pericardium- no signs of pathologies.
Computer Tomography (CT) examination of the cervical (neck) and upper mediastinum: Normal image of the internal, external sections of the jugular veins, No abnormalities found in the in terms of venous width and passages. Normal junctions with the brachycephalic truncus and left subclavian vein. Normal azygos vein and vena cava junction. Normal vena cave superior. No pathological formations observed in the soft tissues of the neck.
Conclusions: Normal CT venography of the neck and mediastinum venous structures.
Doppler examination of the jugular veins:
V . julgaris int. sin- maximum diameter 10mm. in the middle segment- 6.2 mm, around the carotid bulbous - 5 mm, vertebral veins in the sitting position: V . julgaris int. sin- middle segment 6mm, V . julgaris int. dex. middle segment 4mm.
Invasive diagnostic and therapeutic procedures performed:
Angiography of the V. cava superior, the two jugular veins, and V. azygos. A highly advanced membrane type stenosis was found in the middle segment of V . julgaris int. sin, and a highly advanced annulus type stenosis was found at the junction of V. julgaris int. sin towards the V. subclavis sin.
A single stage Percutaneous Transluminal Angiography (PTA) on the V. julgaris int. sin was performed. A long 7 Fr Destination introducer was inserted with a 0.035 lead wire and a balloon dilation angioplasty was performed with four inflations with an Evercross 10.00 X 60 mm at 16 atm pressure. The blood flow was fully restored and the stenosis was minimized to a residual 10%.
Neurological consultation:
The patient diagnosis of MS primary progressive form was established 15 years ago. The EDSS score assessment result is 6.0.
Therapeutic schedule:
Heparin, Baclofen, Viregyt, Thiogama, Vitamin A , B, and C.
Course of disorder-discussion:
angiographic data established a highly advanced membrane type stenosis in the middle segment of V . julgaris int. sin, and a highly advanced annulus type stenosis at the junction of V . julgaris int sin towards the V. subclavis sin. A single stage Percutaneous Translurninal Angiography (PTA) on the V.julgaris int sin was performed with a positive outcome result, improved blood drainage and reduced stenosis to an insignificant 10%, the procedure was conducted without complications.
Recorded complications: None reported
Patient status at hospital discharge:
The patient was released on the first post-procedure day, hemodynamically stable, the access puncture area was in good condition, and they were given instructions for post-procedure rehabilitation by the treating physician.
Home therapy prescribed:
Aspirin Protect 100 mg one a day in the evening after eating and continued MS treatments prescribed by a neurologist specialist.
Medical Outcome:
Improved health condition
General Recommendations:
Physical activity rehabilitation.
Recommendations to the patient and General Practitioner (GP):
We recommend monthly check-ups with a GP or neurologist to track the patient's MS condition. In the case of hemorrhagic or neurological complications related to the medical service provided, immediately contact either Dr. Ivo Petrov or Professor Grozdinski for medical consultation.
The patient has been informed they have the right to two free medical follow up exams within one month from the date of discharge from the hospital The patient was given two copies of the medical report.
