12.11.16 Final bits

Chronic cerebrospinal venous insufficiency

• • Compromised flow of blood in the veins draining the CNS

    • Hypothesised to play a role in the cause or evolution MS

    • Malformed blood vessels cause increased deposition of iron in the brain, which in turn triggers autoimmunity and degeneration of the nerve's myelin sheath

  • Proposed procedure (Zamboni liberation procedure or Zamboni liberation therapy) involving angioplasty (or stenting) of certain veins in an attempt to improve blood flow

    • No firm evidence this exists, or that the procedure does more harm than good

Cerebellar haemangioblastoma

• • CNS tumors that originate from the vascular system usually during middle-age

  • Sometimes may occur in other sites such as the spinal cord and retina

  • May be associated with other diseases such as polycythemia, pancreatic cysts and Von Hippel-Lindau syndrome

  • Most commonly composed of stromal cells in small blood vessels

  • Classed as grade one tumors under the World Health Organisation's classification system

DaT scan

• • DaTSCAN is a solution of ioflupane (123I) for injection

    • Ioflupane has a high binding affinity for presynaptic dopamine transporters (DAT) in the brains of mammals, in particular the striatal region of the brain

    • Use gamma camera to image transporters

  • Indicated in cases of tremor of unknown origin

  • Not useful for diagnosing Parkinsons by itself

    • c.f. Multiple system atrophy (MSA) + progressive supranuclear palsy (PSP), which also involve loss of DaT