Chronic cerebrospinal venous obstruction (CCSVO)
We assess patients with multiple sclerosis, chronic fatigue syndrome, rosacea and other chronic multi-system diseases with non-invasive ultrasound assessment of their jugular and vertebral veins to diagnose the presence of chronic cerebrospinal venous obstruction (CCSVO)
|Diagram 1; Schematic diagram demonstrating blood volume flow (BVF) measurement sites J1, J2, J3 in the internal jugular vein (IJ
CCSVI is a syndrome originally postulated by Professor Paolo Zamboni, a well-known Italian vascular surgeon, where abnormal flow of blood (reflux) in veins draining the brain and spinal cord is associated with multiple sclerosis (MS). In contrast, CCSVO is rarely associated with reflux flow and refers to cerebrospinal venous blood flow disturbances with venous obstructions in the major extracranial veins of the head and neck. The veins involved include the internal jugular veins and vertebral veins in the neck. Whereas CCSVI was postulated to be associated with MS, CCSVO is associated with a number of chronic diseases listed above including MS.
The venous obstructions reduce the flow in the neck veins and can result in complete occlusion of these veins, most commonly affecting the vertebral veins that pass down through the spinal vertebrae of the neck. Dr Paul Thibault suggests that these venous obstructions are caused by a chronic persistent venulitis caused by the obligate, intracellular parasite called chlamydophila pneumoniae (Cpn). This parasitic bacteria has also been associated with other vascular diseases including coronary artery disease, cerebrovascular disease and aortic aneurysms.
If a patient is diagnosed as having CCSVO on blood testing and neck vein ultrasound examination, they will usually be advised to commence on a prolonged combined antibiotic protocol (CAP) specifically designed to treat chronic persistent Cpn infection along with some essential supplements and dietary modifications. This appears to benefit both the venous blood flow in the affected veins and helps control many of the chronic symptoms.
|Diagram 2: The termination of the thoracic duct at the confluence of the subclavian vein, left internal jugular vein and left vertebral vein.
Dr Paul Thibault's published articles on CCSVO are available for download-
- Chronic Cerebrospinal Venous Obstruction - Clinical Manifestations, Diagnosis and Treatment
- Duplex Ultrasound Examination
- A Prolonged Antibiotic Protocol to Treat Persistent Chlamydophyla Pneumoniae Infection
- Neck Vein Obstruction; Diagnosis, and the role of Persistent Chlamydophyla Pneumoniae Infection
Dr Paul Thibault appearing on Catalyst - transcript