Chronic Cerebrospinal Venous Insufficiency: An Overview Chronic cerebrospinal venous insufficiency, more popularly known by its acronym as CCSVI, is a long standing disorder which primarily involves the blood vessels which drain blood from the brain and the spinal cord. In this disease, there is a decrease in the rate at which the veins remove the deoxygenated blood from the brain and the spinal cord, because of a narrowing of the lumen of the veins, a phenomenon known as stenosis. This condition was most commonly found to be in association of another degenerative disorder of the central nervous system, multiple sclerosis. Chronic venous insufficiency is a condition which can affect any of the organs of the body, but it is more commonly seen in the liver, lungs and the spleen. The organs which are affected mainly show slowly progressing degenerative changes in them, and this degeneration is because of the inability of the venous system to drain the deoxygenated blood from the organ. This accumulation and pooling of deoxygenated blood leads to a progressive decline of the oxygen levels at the tissue level in the organ affected (tissue hypoxemia) leading to subsequent damage and death. When these changes happen in the brain and the spinal cord, the condition is known as chronic cerebrospinal venous insufficiency. Put simply enough, it is the progressive damage of the brain and the spinal cord and associated tissue by slowly depriving them of oxygenated blood. The brain is one of the most complex organs in the body, but its metabolic needs are simple enough i.e. simple sugars like glucose is the only fuel that the brain runs on, unlike the ability of the other tissues in the body to switch over to ketone body and lipid associated metabolic pathways, nervous tissue rely only on glucose as the source of their metabolic needs. And if the brain is deprived of its glucose and oxygen, it usually results in the stoppage or reduction in its function. Symptoms of chronic venous insufficiency of the central nervous system can include: • • • • •
Fatigue, increasing as the day progresses Headaches when supine (face up position) Gradual and progressive loss of voluntary control over bladder and bowel movements. Reduction in motor and sensory acuity Memory deficiency
The diagnosis of CCSVI is based on demonstrating the narrowed or obstructed venous circulation of the central nervous system. This can be done by with the use of dye injection venograhy, MRV (magnetic resonance venography) and colour Doppler studies. Ever since the Italian physician Paolo Zamboni first demonstrated a concrete co-existence of CCSVI and MS, the pathogenesis or the disease process and development of the two have always been looked to be linked to each other. Though there is a stage of the development of vascular lesions in the process of MS, it is commonly found in the blood vessels present within the substance of the brain and even though there is a thickening of the surrounding of the vessels, it is not frankly enough to cause an impedance to the flow of the blood in the veins. Treatment of chronic cerebrospinal venous insufficiency is surgical dilatation of the veins which are affected, by a process of balloon angioplasty. Here a thin wire is introduced into the veins, which has a small balloon fitted at the end. This balloon is then expanded when it is guided near the location of the stenosis, causing the veins to dilate with them, thus improving the circulation.