Cerebrospinal Venous Obstruction: Anatomy, Clinical Presentation, Diagnosis, and Treatment of Chronic Infective Cerebrospinal Venulitis

Abstract

This review chapter describes the normal anatomy and function of the cerebrospinal venous system, ultrasound diagnosis of obstructions in the system, and the clinical implications and treatment of chronic cerebrospinal venous obstruction (CCSVO) associated with chronic persistent Chlamydophila pneumoniae (Cpn) infection. The normal patterns of flow in the cerebrospinal venous system are described and guidelines for the interpretation of the extracranial duplex ultrasound (ECDU) examination of the neck veins are presented. An infective cause of CCSVO is proposed and relevant pathology tests necessary for a diagnosis of chronic persistent Cpn venulitis are discussed. A treatment protocol for Cpn chronic venulitis is described and recommended. The progress of the patient with CCSVO can then be followed and monitored by using the ECDU and relevant pathology tests after 3 and 6 months. CCSVO is a relatively common condition encountered in chronic diseases of unknown etiology and is often neglected by medical practitioners when managing patients with symptoms of brain fog, chronic headaches, and fatigue. Objective diagnostic and treatment protocols are required to make further progress with these conditions.