ISNVD Abstract Book

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there must be a lowered resistance against abrupt widening of epidural target veins and a corresponding emptying of separate cerebrospinal veins. CONNECTING DOMAIN: SHORT, WIDE, SEPARATE Abrupt overburdening of a cerebral or spinal target domain will changeably be counteracted by arterial pulsations or venous reflux simultaneously invading the craniovertebral space. The wider the pathway of venous reflux, the stronger and more widespread its peripheral impacts can become. The most essential property of the connecting domain of a venous reflux is the noticeable absence of local excess pressure diversion, or its dispersion through venous collaterals: Here, inside the skull, structure and interconnections of the dural sinuses approaching the so-called confluence of sinuses gain primary importance; inside the spinal canal, ease and speed of flow distribution within the meshes of epidural veins are decisive. Gradual washing out of the channels of venous reflux as well as of the secondary fluid shifts in and out of the craniovertebral space promotes a long term enhancement of venous reflux activity. Thereby white matter is in several respects more at risk than grey matter. In this context, the ways in which MS affects the brain are particularly revealing. Peaked or rounded lesion waves surge up along Steiner’s Wetterwinkel; Dawson’s fingers emerge from subependymal veins, then radiate out along particular affluent veins; farther out lengthy ovoid Steiner’s splashes embed venous turns and branching points; eventually lesions are prevented from invading central and cortical grey matter, and so expand in between two cerebral convolutions or form a “ crescent“ around their trough. Reflux into the spinal canal dissipates its energy by locally engorging epidural veins, causing headward displacement of easily shifted content of the dural sac. Spinal cord and nerve roots are burdened by local venous expansions and extensive subdural volume shifts. The specific literature reveals many striking resemblances between what is seen in post mortem studies of spinal MS and what results from different forms of mechanical impacts displacing the spinal cord in relation to its sheaths. TARGET DOMAINS: THERE IS A DIRECT AND CAN ALSO BE SOME REMOTE ONES In keeping with its speed, massiveness and duration, venous reflux may balloon or otherwise deform its target vessels, depending on local deceleration of rejected blood and fluctuations in perivascular perfusion and CSF pressure. This endangers primarily the most vulnerable structures in the burdened venous channels’ surroundings.
CHARCOT‘S FIRST POST MORTEM DRAFTS ON MS: BURIED SINCE JUNE 1866 Franz Schelling, M.D. Fingstr. 32 6974 Gaißau +43 5578 71543 www.ms-info.net The book “Multiple Sclerosis: The Image and its Message” offers a Synopsis of the historic post mortem evidence on MS Critique of vague notions which have supplanted concrete findings made in MS Discussion of the role of veins in cerebral and of ligaments in spinal MS.
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POSTER ABSTRACTS Monday, February 2
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