CCSVI - a szklerózis multiplex vénás eredete

Egy olasz doktor, Paolo Zamboni felveti, hogy az SM (szklerózis multiplex) egyik fontos faktora lehet a nyaki vénás keringés elégtelensége. Eredményeit a világ számos országában alkalmazzák. Magyarországon még nem.
“Először átnéznek rajtad, aztán kinevetnek, aztán harcolnak veled, és végül nyersz.” (Mahatma Gandhi)
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Friss topikok

isnvd5thlogo-c.pngVéget ért az ISNVD 2015-ös konferencia, ahol bemutatták a legújabb tudományos eredményeket, melyek a véráramlás és az idegrendszer kapcsolatáról szólnak. Mivel ez főként orvosokat érdekel és az anyag szerencsére hatalmas, ezért nem tudom még csak összegezni sem, vagy az összegzéseket lefordítani sem.

Itt letölthetők a 2015-ös absztraktok (pdf).  Ami jól látható számomra: a CCSVI kutatás gőzerővel zajlik és új területek nyílnak. Íme egy rövid összegzés Joan tollából:

2D and 3D analysis of vessels in the retina and the brain
Prof. Bart ter Haar Romeny, Ph.D.1,2
1Eindhoven University of Technology, Eindhoven, the Netherlands 2Northeastern University, Shenyang, China
This research is using the imaging of blood vessels in the eye's retina to get a picture of how blood is circulating throught the central nervous system. The blood vessels in the retina give an early picture of how brain diseases and breakdown of the blood brain barrier might be developing. Scanning the eye is easier and more cost-effective, as well.

Venous dysfunction and neurodegenerative diseases
Chih-Ping Chung MD PhD
Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
Dr. Chung and his group have been studying the venous vasculature in relationship to brain disorders for over a decade. He has spoken at a few of the ISNVD conferences now. His new research focuses on how venous abnormalities are linked to white matter changes and how venous drainage impairment leads to dysfunction in Alzheimer's Disease.

Blood storage within the intracranial space and its impact on cerebrospinal fluid dynamics

Clive B Beggs 1, Simon J Shepherd 1, Pietro Cecconi 2 and Maria Marcella Lagana 2Medical Biophysics Laboratory, University of Bradford, Bradford, BD7 1DP, UK  Fondazione Don Carlo Gnocchi ONLUS, IRCCS S. Maria Nascente. Milan, Italy 
This study measured blood flow throughout the cardiac cycle by using MRI to visualize the flow in the necks of 14 healthy adults.  This study found that it is cerebrospinal fluid (CSF) which controls the volume changes inside the brain.  CSF interacts with the cortical veins to facilitate how much blood is stored.  This is an important finding, because any disturbance in venous outflow of blood and CSF will change the blood storage inside the skull, potentially leading to reduced cerebral circulation.

Advances in Treatment Strategies of Extracranial Venous Disease
Hector Ferral, MD
Senior Clinical Educator NorthShore University Health System
Dr. Ferral has been treating people with CCSVI for a few years now. He has also been an attendee and presenter at the ISNVD before. His new presentation will be looking at the technical advances being made in vein measurement and treatment of CCSVI.

Imaging of Brain Microvascular Disorders: lessons from the CADASIL model.
Hugues Chabriat, MD PhD;Department of Neurology, GH Lariboisiere, APHP, INSERM UMRS1161, University Paris 7 Denis Diderot, Paris France.
This research uses imaging to look at how the small vessel disease related to stroke and dementia develops and progresses.

Endothelin- 1 as a potential target for chronic brain hypoperfusion
Jacques De Keyser, MD, PhD, Free University of Brussels (VUB), Department of Neurology, Brussels, Belgium
This study is near and dear to my heart, as it is looking at how ET-1, a marker of endothelial dysfunction, is related to slowed blood flow in the brain, called hypoperfusion. People with MS have much higher levels of ET 1 in their blood than normals, and much slower cerebral blood flow. We also see this marker elevated in a number of neurodegenerative diseases, like Alzheimer's. In this study, the researchers used bosentan, a blood pressure medication, to treat ET 1 levels. This treatment increased cerebral blood flow in pwMS, and lowered ET-1 levels. (But bosentan has side effects, and is not easy on the liver. Much better, in my opinion, to lower ET-1 levels by addressing endothelial dysfunction, through diet, exercise, and lifestyle.)

TBI and hemodynamic changes in the brain

James R. Stone, MD, PhD
This presentation is looking at how traumatic brain injury induces ischemia, or a low-oxygen state, in the brain. TBI also changes cerebral blood flow and can cause a break in the blood brain barrier, igniting the immune system. New research is showing how explosive devices can cause TBI, even without direct physical contact.

Ultrasound contrast imaging of brain hemodynamic and perfusion Marcello Mancini, M.D.
Institute of Biostructure and Bioimage – CNR
Naples, Italy
This presentation will be looking at how new MRI and ultrasound technologies are allowing researchers to view cerebral circulation in MS.  People with MS show signs of hypoxia (low oxygen) injury and thrombosis (small clots) in the small veins of the brain. New technologies are allowing us to see that cerebral transit time is slowed in MS. 
Imaging of the Microvasculature
E. Mark Haacke, PhD 
Dr. Haacke, a presenter at all of the ISNVD conferences, returns this year to discuss how his invention of susceptibility weighted imaging (SWI) and MRA can be used to study the neurovascular system, and clarify the relationship between the venous sytem and CSF.

Update in computational fluid modelling of the brain
Mauro Ursino
This presentation is using mathmatical and computer models to simulate the complex mechanisms affecting cerbral circulation. Using these models shows how postural changes and stenosis in extra cranial arteries and veins can change upstream intercranial circulation.

Clinical Applications of Venous Treatment
Dr. Michael Dake, Stanford University
Dr. Dake, last year's ISNVD president and a founding member, will be presenting on the contributions of 2014 studies which have enhanced understanding of how endovascular and open surgical treatment of venous abnormalities has affected patients with MS, Alzheimer's disease, Parkinson's, POTS and other pathologies.
The Heart Brain Connection
MJ Daemen
Dr. Daemen is the keynote guest speaker. He is a neurocardiologist, a member of a new field of experts who are bringing together an understanding of how the heart and brain affect each other. As a member of the Dutch Heart Foundation, his group is looking at how cardiovascular disease is influencing cognitive function and cerebral circulation.

Paolo Zamboni, Francesco Sisini, Erica Menegatti, Giacomo Gadda, Mirko Tessari, Mauro Gambaccini
Vascular Diseases Center, University of Ferrara, Ferrara, Italy 
Dr. Zamboni's group is using ultrasound in the B mode (brightness mode) to measure the pulse wave in the jugular vein.  The way that the wave form looks is currently used to monitor for heart disease, however Dr. Zamboni's group is using this technique to find CCSVI.

Is there a role for mast cells dependent synthesis of Endothelin-1 in neurodegenerative diseases?
Pedro D’Orléans-Juste-1, Louisane Desbiens, Denis Gris-2
Departments of Pharmacoly-1 and of Pediatrics-2, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, PQ, Canada
We know that levels of ET-1 (a marker of endothelial dysfunction) and mast cells (tissue cells of the immune system) occur in higher levels in people with MS.  This study uses the mouse model of EAE as well as a human isoform to study how mast cells found in the vicinity of spinal lesions are involved in the synthesis of ET-1.
Venous abnormalities in Meniere's Disease
P.M.Bavera; P. Cecconi; D. Alpini; F. Di Berardino 
This presentation will be using slides to show the correlation and differences between Meniere's Disease and MS, in regards to CCSVI imaging.  There are specific characteristics to the venous abnormalities seen in Meniere's.
Advances in Idiopathic Intracranial Hypertension Pathogensis: a Focus on Sinus Venous Stenosis
Roberto De Simone, Angelo Ranieri
Headache Centre  Dpt. of Neurosciences, Reproductive Sciences and Odontostomatology University of Naples “Federico II”
This research is focusing on how stenosis of the venous sinus is related to idiopathic intracranial hypertension (IIH)  There is a feedback loop which appears to occur in this situation.  The venous sinus collapses, cerebrospinal fluid pressure builds, which creates more compression.  Endovascular stenting of the venous sinus is a currently approved treatment to end this cycle of stenosis and hypertension.

In Endothelial function, the glymphatic system and New Drug Development
Endothelial dysfunction in neurodegenerative disease

J. Winny Yun, Emily Stevenson, Seiichi Omura, Fumitaka Sato, Ikuo Tsunoda, Alireza Minagar, Felix Becker, Trevor Castor, Adam Xiao, J. Steven Alexander, LSUHSC-Shreveport Molecular and Cellular Physiology, Microbiology, Virology, Neurology, Shreveport, Louisiana, USA.
Dr. Steven Alexander from LSU returns to the ISNVD to again discuss the endothelium in neurovascular disease. There is a vascular association of specific biomarkers found in MS. This new research is looking for a means to regulate these neurolymphatic markers, to help those with neurovascular diseases.

Fluid Dynamic Influences on Cerebrovascular Endothelial Activation Responses
Dr. Alexander and the LSU team look at how blood flow over endothelial cells affect their health. Laminar shear stress (regular blood flow) over endothelial cells is essential to their function. Disrupted flow causes endothelial cells dysfunction and death. Shear stress alterations could lead to a break down of the endothelial layer in the brain, and create a disturbance in the blood brain barrier and inflammation.

Cardiovascular risk factors and neurodegenerative disorders
Dr. Robert Zivadinov
Buffalo Neuroimaging Analysis Center, Department of Neurology, University at Buffalo, State
This research finds an association with cardiovascular risk factors (smoking, obesity, inactivity, high blood pressure) and MS.  MS patients who had one or more CV risk factors had higher lesions loads and more brain atrophy.




A 2014-es kutatási anyagok:


Véget ért az ISNVD 2014 -es konferencia, ahol bemutatták a legújabb tudományos eredményeket, melyek a véráramlás és az idegrendszer kapcsolatáról szólnak. Mivel ez főként orvosokat érdekel és az anyag szerencsére hatalmas, ezért nem tudom még csak összegezni sem, vagy az összegzéseket lefordítani sem. 

Ami jól látható számomra: a CCSVI kutatás gőzerővel zajlik és új területek nyílnak. Figyelemre méltó például számomra az SM-en kívül, hogy Dr. Haacke vénás áramlási problémákat talált Parkinson kórban is.

Itt letölthető az ISNVD 2014 newsletter pdf-ben, melyben találunk rövid összefoglalókat az előadásokról.

Itt letölthető az ISNVD 2014 Program Book pdf-ben, melyben megtalálhatóak az előadások abstract-jai.

Itt alant pedig az egyes előadások prezentációi tölthetőek le:

Keynote Presentation - The Role of Blood Vessels and Inflammation in the Pathogenesis of Neurological Disorders

Dr. Paula Grammas

Welcome Reception



Welcome and Introduction


Session 1: A Multi-Modality Approach to Extra Cranial Venous Disease

Session Chairpersons: Dr. Robert Zivadinov 

The Current Status of Ultrasound Imaging for the Screening of CCSVI

Dr. Marcello Mancini

What is the Normal Jugular Vein Valve Function?

Dr. Erica Menegatti

Prevalence of Extracranial Venous Narrowing on Catheter Venography in People with Multiple Sclerosis: Results of a Blind Study. 

Dr. Lindsay Machan

Identifying CCSVI with Cervical Plethysmography

Dr. Paolo Zamboni

Diagnostic Contributions of Catheter Venography for Screening of CCSVI

Dr. Hector Ferral

What Additional Information Can Intravascular Ultrasound Provide?

Dr. Adnan Siddiqui

Molecular Markers of Abnormal CNS Hemodynamics

Dr. Steven Alexander

State of the Art I: Why We Need a Multi-Modality Diagnostic Approach for CCSVI

Dr. Robert Zivadinov



Submitted Abstract 1 - Extracranial brain draining veins in a mouse: Assessment by High Resolution Ultrasound and MR Angiography of the neck 

Marcello Mancini, M.D., Giuseppe Palma, Ph.D., Enrico Tedeschi, M.D., Adelaide Greco, Ph.D. , Monica Ragucci 

Submitted Abstract 2- Inverse Relationship between Internal Jugular Vein Narrowing and Increased Brain Volumes in Healthy Individuals

Chris Magnano, M.S., Pavel Belov, Jacqueline Krawiecki, Steven Grisafi, Jesper Hagemeier, M.S., Clive, B. Beggs, Ph.D., Robert Zivadinov M.D., Ph.D. 

Refreshment Break – Technical Exhibits


Session 2: The Treatment of Abnormal Venous Flow

Session Chairperson: Dr. Ziv Haskal

Designing an Endovascular Trial – What Elements are Essential and Why CCSVI Trials Might Differ from Disease Modifying Trials?

Dr. Kottil W. Rammohan

State of the Art II: Current Results of Safety and Efficacy of CCSVI Therapy in MS Patients

Dr. Gary Siskin

Procedural Endpoints: How to Best Measure Meaningful Flow Impairment, Inter- and Post-Procedural Therapy


A - IVUS Driven Intervention

Dr. Hector Ferral

B. Optimizing Pure Venographic Therapy

Dr. Hector Ferral

Intervention Studies in 2014:


A. The Time is Ripe for Primary and Replicative Therapy Trials in MS

Dr. Ziv Haskal

B. Therapy Trials Need to Wait. The Landscape has Changed

Dr. Kottil W. Rammohan



Submitted Abstract 3 - A Report of Four Cases of Anterior Cranial Fossa (Ethmoidal Type) Dural Arteriovenous Fistula: Surgical Considerations andTechnique Using Intraoperative Indocyamine Green Angiography. 

Kuhyun Yang, M.D., Jae Sung Ahn, M.D., Ph.D., Jung Cheol Park, M.D., Do Hoon Kwon, M.D., Byung Duk Kwun, M.D., Ph.D.

Submitted Abstract 4 - Classification of Venous Outflow in the Extracranial Vessels in a Large Cohort of MS Patients 

Sean Sethi, MS, David Utriainen, Robert Loman, MD, Imran Saqib, E. Mark Haacke, Ph.D.

ISNVD Business Meeting and Lunch


Session 3: Potential Role of Extracranial Venous System in CNS Disorders and Aging 

Session Chairperson: Dr. Chih-Ping Chung

CCSVI and Parkinsons Disease

Dr. E. Mark Haacke

Etiologies of Jugular Venous Abnormalities in Transient Monocular Blindness

Dr. Chun-Yu Cheng

Age-Related White Matter Changes, Alzheimer’s Disease and Jugular Venous Reflux.

Dr. Clive Beggs

Cerebral Venous Drainage Impairment in Idiopathic Intracranial Hypertension

Dr. Noam Alperin

Headache and Venous Abnormalities

Dr. Wei-Ta Chen

Venus Abnormalities Involved in High Altitude-Associated Neurological Disorders

Mr. Mark Wilson

Cerebral Venous Drainage Impairment And Cerebral Small Vessel Disorders

Dr. Han-Hwa Hu

The Role of Inflammation Factors in Chronic Cereral Venous Insufficiency: From The View of Lower Limbs’ Venous Disorders.

Dr. Chris Imray

The Future Perspective of Researches on Neurological Diseases Associated with Chronic Cerebral Venous Insufficiency.

Dr. Chih-Ping Chung



Submitted Abstract 5 - The Nature of Abnormal Ultrasongraphic findings in Internal Jugular Veins

Chun-Yu Cheng, M.D., Han-Hwa Hu, M.D., Chih-Ping Chung, M.D. 

Submitted Abstract 6 - CCSVI is Associated with Subcortical Deep Gray Matter Abnormalities in Healthy Individuals. A Diffusion Tensor MRI Study

Roberto Cappellani, Niels Bergsland, Jesper Hagemeier,  Karen Marr, Cheryl Kennedy, Ellen Carl, Deepa P. Ramasamy, Michael G. Dwyer, Bianca Weinstock-Guttman, Robert Zivadinov

Refreshment Break – Technical Exhibits


Session 4: Quantifying Flow in Neurological Diseases

Session Chairperson: Dr. Michael Dake

Normal Regulatory Mechanisms of CNS Blood Flow

Dr. Eric C. Peterson

Understanding the Blood-Brain Barrier in Health and Disease

Dr. Steven Alexander

Origin of Craniospinal CSF Flow Pulsation and How We Measure It

Dr. Noam Alperin

The Lymphatic System: What is its Normal Role and What Can Go Wrong?

Dr. Roy O. Weller

The Use of Biomarkers to Evaluate Glymphatic System Function

Dr. Leonard Prouty


Venous Hemodynamics in Neurologic Disorders

Dr. Clive Beggs

Theoretical Study of Cerebral Venous Haemodynamics Associated with the CCSVI Condition

Dr. Eleuterio Toro



Submitted Abstract 7 - Observed differences of PC-MRI measured venous outflow and CSF pulsatility in migraine subjects receiving Atlas Correction Intervention 

H. Charles Woodfield, BS Pharmacy, DC1, Clive Beggs, PhD, D. Gordon Hasick, DC3

Submitted Abstract 8 - Relationship between Jugular Venous Reflux and Perihematoma Edema and Outcome after Spontaneous Itracerebral Hemorrhage 

Hao Feng, Xingquan Zhao, Hongxia Zhang†, Ye Cheng†, Liping Liu


Introduction and Announcements


Session 5: Monitoring Hemodynamics of the Brain

Session Chairperson: Dr. E. Mark Haacke

Nitric Oxide and a Vascular Hypothesis in Multiple Sclerosis

Dr. Yulin Ge

Perfusion Imaging in Stroke: Its’ Current Clinical Status and its Role in Treating Patients

Dr. Larry Latour

Hemodynamic Impairment in Multiple Sclerosis: Imaging Techniques and Perspectives

Dr. Yulin Ge

SPECT and PECT Perfusion Changes After CCSVI Restoration

Dr. Paolo Zamboni



Submitted Abstract 9 - Cerebral Hemodynamic Changes in Mild Traumatic Brain Injury at the Acute Stage 

Hardik Doshi, Wentao Wang,  Robert Welch, Brian O’Neil, Grace Ma, Randall Benson, E Mark Haacke and Zhifeng Kou

Submitted Abstract 10 - Altered IJV hemodynamics and impaired cerebral autoregulation in patients with panic disorder

Yu -Chien Tsao, Chun-Yu Cheng, I-Hui Wu, Chih-Ping Chung, Han-Hwa Hu

Refreshment Break – Technical Exhibits


Session 6: Traumatic Brain Injury (TBI) and Vascular Consequences

Session Chairperson: Dr. E. Mark Haacke

State of the Art IV: Understanding the Fundamental Physiology of TBI: From Research To Treatment

Dr. Ramon Diaz-Arrastia

Typical Vascular Lesions of TBI and Their Evolution

Dr. Gunjan Parikh

The Clinical Spectrum and Natural History Of TBI Sequelae

Dr. Karen Tong

State of the Art IV: The Role of Imaging and Venous Abnormalities in TBI

Dr. Zhifeng Kou

Submitted Abstract 11 - Hemorrhagic lesions based on venous and arterial damage and its clinical correlation in Traumatic Brain Injury 

Hardik Doshi, JunLiud, Robin Hanks, E Mark Haacke, Zhifeng Kou

Submitted Abstract 12 - Thalamic Shape and Cognitive Performance in Amnestic Mild Cognitive Impairment 

Hyun-Kook Lim, Seung-Chul Hong 







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