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Q: "Venous reflux: cause of specific findings in multiple sclerosis at p.m./on MRI" ( Answered,   1 Comment )
Subject: "Venous reflux: cause of specific findings in multiple sclerosis at p.m./on MRI"
Category: Science
Asked by: willofrobertcarswell-ga
List Price: $200.00
Posted: 30 Oct 2003 01:40 PST
Expires: 29 Nov 2003 01:40 PST
Question ID: 271074
Is there a person or institution studying the risks of venous reflux
(venous flow inversions, venous regurgitations, venous back-jets) into
the brain? the relevance of this problem for definite forms of multiple sclerosis?

Request for Question Clarification by pafalafa-ga on 30 Oct 2003 08:41 PST
Interesting question you've posted here, willofrobertcarswell.

There seems to be only one scientific paper that directly addresses
the topic of your is authored by Dr. Schelling, the same
person identified in till-ga's comment, below.  The paper dates back
to the 1980's.

Dr. Schelling appears to no longer refer to "venous reflux" (or
similar terms) as an explanatory concept, but his overall hypothesis
is still consistent with the role or irregular pressures in the veins
as a contributing factor to MS.

There are a number of other papers that tie together MS and
hydrocephalus, a condition which itself has been related to venous
reflux...I would be glad to point you to this body of research, if it
would be of interest to you, as well as highlighting the main points
of Dr. Schelling's work.

Given the apparent scarcity of research on this topic, please let the
researchers here know how you would like to proceed.



Request for Question Clarification by pafalafa-ga on 30 Oct 2003 12:50 PST
In addition, if you could clarify what you meant by the title of your question:

Venous reflux: cause of specific findings in multiple sclerosis at p.m./on MRI

that would be a help as well.  I'm a bit confused by the "p.m./on MRI" piece of it.

Request for Question Clarification by pafalafa-ga on 07 Nov 2003 20:26 PST
Hello again,

Just wondering if there's any additional information you can add to
this.  I've continued looking into your question, and I may be able to
post an answer, but it would help me focus my efforts if you could
respond to my earlier comments and questions.


Subject: Re: "Venous reflux: cause of specific findings in multiple sclerosis at p.m./on MRI"
Answered By: pafalafa-ga on 15 Nov 2003 06:24 PST
Thank you for a most intriguing question.  I have posted my answer
below, but I want to put an important caveat right up front ? I am not
a doctor or a medical researcher.  Although I believe I have given you
a well-crafted summary of existing medical information, you should
certainly not base any medical decisions on the information I have
presented here without first consulting a medical professional.

If you find anything below is not clear ? or if you need additional
information ? just let me know, and I?ll be happy to assist you

All the best....



Dr. Schelling from Austria, whose work has been mentioned in earlier
postings, appears to be the chief ? perhaps the sole ? proponent of a
medical hypothesis linking multiple sclerosis to physical forces
introduced by venous reflux.

The principle piece of evidence that Dr. Schelling finds compelling is
the presence of a characteristic feature known as ?Dawson?s Fingers?
in the brain.  Schelling agrees with some other researchers who have
attributed these features to some sort of process of physical damage,
as opposed to a disease-agent.  He has taken the observation a step
further by postulating that the Dawson?s Fingers are caused by venous
pressure against cerebral tissues, due to a condition of venous
reflux; Schelling also refers to these more commonly as back-jets.

Schelling?s work is presented at two web sites, and in a paper from
1986.  I have summarized these below, and provided excerpts from
Schelling?s work when it seemed they would be particularly
informative.  There are copyright limits to how extensively I can
quote his work, however, so I would certainly urge you to visit the
sites yourself.

Dr. Schelling also freely posts his contact information in a manner
suggesting that he invites queries from those interested in his ideas.
 I would also certainly encourage you to follow up your own interest
in this topic by contacting Dr. Schelling in Austria.  His contact
information is:

Franz Alfons Schelling, MD
Arlbergstr. 3
A-6850 Dornbirn
Tel|Fax ++43 5572 26804


Dr. Schelling?s hypothesis was elaborated in a 1986 paper published in
Medical Hypotheses; an abstract of the paper can be seen at the PubMed
site of the National Library of Medicine:


Med Hypotheses. 1986 Oct;21(2):141-8. 

Damaging venous reflux into the skull or spine: relevance to multiple sclerosis.

Schelling F.

Unequal propagation of central venous excess pressure into the
different cerebral and spinal venous drainage systems is the rule
rather than the exception. The intensity of the forces thus to be
exerted on vulnerable cerebrospinal structures by the resulting
pressure-gradients in the craniovertebral space is unknown. There is a
need to consider the various conditions which may cause individual
proneness to heavier reflux into particular cerebral as well as epi-
and subdural spinal venous compartments. An attempt is made to
indicate eventual consequences of excessive retrograde dilatation
especially of internal cerebral veins. The importance of elucidating
the neuropathological and clinical implications of undue reflux into
the skull or spine is deduced from the probability of relations
between localized backflow into the craniovertebral space and
unexplicated cerebrospinal diseases. In this regard the features of
multiple sclerosis are discussed.


Here, Dr. Schelling is making the case that venous reflux can cause
internal pressure gradients large enough to damage vulnerable areas of
the brain and spine, and he creates a tentative link to MS.   Beyond
this, however, Schelling does not seem to have further developed his
ideas in the context of conventionally-published medical research
papers.  Instead, he has taken to the web to put forward his more
recent ideas on how venous reflux (a term he seems to use only rarely
now,  favoring the use of ?back-jets?) can initiate a cascade of
events that contribute to MS.  Schelling also holds out the hope that
understanding these events can lead to new treatment options.

Dr. Schelling?s web site expounding on his ideas can be visited here:

By clicking on the ?Table of Contents? link, you will see that the
site is presenting, in essence, a book of Dr. Schelling?s ideas:

which is presented in five parts:

(I) Multiple sclerosis: Genuine naked-eye identification 

(II) Histological perspectives 

(III) The neurologist?s standpoint 

(IV) The specter of the multiple sclerosis agent 

(V) Lesion explanation in physical terms

The last part ? Part V ? contains the explanations of venous reflux as
a factor in MS, and I?ll excerpt some of that material below.  But the
front page of Schelling?s site also offers another compelling link. 
By clicking on the text that reads:

A Crash Course on the Meaning of the "Dawson's Fingers".
If you want to see, how "Dawson's fingers" emerge, click here 

Doing so will take you to a graphical presentation of how venous
backflow initiated in the chest can produce Dawson Fingers in the
brain.  The presentation illustrates four key steps:

--Buildup of venous excess pressure in the chest

--Venous reflux (back-jet) in a jugular vein

--Engorgement of straight sinus' affluents, associated with
traumatization of cerebral tissue via venous expansions

--Outflow is vented from cerebral veins.

Getting back to Schelling?s on-line book on multiple sclerosis, at
this link to Part V of the book:

he explains, in detail, the reflux-MS connection hypothesis:

The specific brain plaques of multiple sclerosis can only be caused by
energetic venous back-jets set in motion by intermittent rises in the
pressure in the large collecting veins of the neck, but especially of
the chest.

Since the process of cerebral multiple sclerosis does not lead to an
even distension of the proximal branches of a particular venous
drainage system up to a definite length, since its plaques emerge
preferentially from venous bends, narrowings and arborizations, and
since the plaque expansions from veins show such striking
eccentricities, the impacts of the regurgitant blood quite clearly
tend to be very unevenly distributed... To be able to exert such
effects the peripherally directed venous currents must at times attain
remarkably high velocities and affect the brain in the course of very
short periods of time.

As to the selective involvement of a definite venous drainage system
in the brain: While injecting, under heavy pressure, carmine-gelatine
into a human body's straight sinus in an attempt to render its
tributary veins in the cerebral hemispheres more prominent, Benno
Schlesinger, in 1939, came unawares very close to explaining the
cerebral multiple sclerosis lesion's genesis. He realized that
extravasations produced around the lateral ventricles' outer angles
(Steiner's "Wetterwinkel") "closely simulate the distribution and even
the shape of plaques in advanced cases of multiple sclerosis" ... In
this way, Schlesinger, an expert on cerebral vascular anatomy, clearly
demonstrated that the most prominent plaque veins represented the main
affluents of the straight sinus. The fact that other affluents of the
straight sinus, i.e. veins of the brainstem, must equally be
considered as classic plaque veins appears to have been noticed only
by Lumsden, in 1970...


Schelling also has another site that summarizes ? in a more ?plain
English?fashion ? his key ideas:

The ?Dawson Fingers? of Cerebral Multiple Sclerosis
Franz Alfons Schelling, MD

Causes of ?Dawson Fingers?

The unparalleled form of  ?Dawson fingers?
and their pattern of arrangement point to a distinct
kind of injurious process whose nature has as yet not 
been properly researched...

The forces which account for the ?Dawson
fingers?? overall pattern of spread obviously act in
a direction which is opposite to that of the normal
flow in the lesions? veins of origin. This...indicate[s] 
that resulting damages must bedue to a definite sort of 
mechanical impact, namely the vehement rejection of venous blood.

The question then arises as to just how
these chronically repetitive back-jets of venous blood
come about. Particularly relevant in this respect
are Schlesinger?s 1939 observations that the lesions
of cerebral multiple sclerosis typically extend from
affluents of the straight sinus ...

For back-jets of central venous blood to become
correspondingly localized the following two conditions
have to be fulfilled:

(i) incompetence of the
valve which prevents the surging up of central
venous blood through an internal jugular vein in the
direction of the brain and

(ii) the lack of any opportunity for a corresponding
escape...of  the rejected blood column from the involved cerebral
drainage system.

The periventricular and pontine ?Dawson fingers?
distinctive mode of spread is thus quite understandable
in view of the course which venous backjets
take in affecting the affluents of the Galenic
vein (fig. 2a) and possibly also an equilateral inferior
petrosal vein (fig. 2b).


And as a final contribution from Dr. Schelling, there is this farily
recent post at a medical forum in which he mentions advances in
medical imaging of Dawson?s Fingers that can possibly lead to surgical
approaches to MS [NOTE however, that as far as I know, this suggestion
has not actually been tried in an actual medical context]:

Can vascular surgery cure MS marked by Dawson-fingers? 

Date Posted:  Dec. 10, 2002 -  10:21:47 AM  

Please consider my analysis of the classic observations of multiple
sclerosis at It reveals specific
cerebral and spinal lesion formations, the peculiar features of which
are only to be explained by venous back-jets. And these back-jets can
be interrupted by surgical interventions.

The distinctive traits of the Dawson-fingers, specific cerebral lesion
formations, are now to be reliably identified also in vivo owing to
advances in serial MR imaging
(, 3D
lesion-modeling, and MR venography.

With this progress there has opened up an opportunity for vascular
surgery to cure hopeless cases of MS.


As I mentioned earlier, Dr. Schelling seems to be the sole proponent
of this particular view that Dawson?s Fingers are caused by venous
backjets and are linked, in that manner, to MS.

However, venous reflux, although not often associated in the medical
literature with MS, is certainly a recognized phenomena, and one that
can contribute to the progression of a disease, as indicated in the
following case study: from Radiology 

Radiology, Vol 194, 671-680

Cerebral dural arteriovenous fistulas: clinical and angiographic
correlation with a revised classification of venous drainage

C Cognard, YP Gobin, L Pierot, AL Bailly, E Houdart, A Casasco, J
Chiras and JJ Merland
Service de Neuroradiologie, Hopital Lariboisiere, Paris, France. 

PURPOSE: To review the symptoms and progression of dural arteriovenous
fistulas (AVFs) and correlate the findings with various angiographic

MATERIALS AND METHODS: Patterns of venous drainage allowed
classification of dural AVFs into five types: type I, located in the
main sinus, with antegrade flow; type II, in the main sinus, with
reflux into the sinus...; type III, with direct cortical venous
drainage without venous ectasia; type IV, with direct cortical venous
drainage with venous ectasia; and type V, with spinal venous

RESULTS: Type I dural AVFs had a benign course. In type II, reflux
into the sinus induced intracranial hypertension in 20% of cases, and
reflux into cortical veins induced hemorrhage in 10%. Hemorrhage was
present in 40% of cases of type III dural AVFs and 65% of type IV.
Type V produced progressive myelopathy in 50% of cases...

CONCLUSION: This classification provides useful data for determination
of the risk with each dural AVF and enables decision- making about the
appropriate therapy...


I hope this summary provides you the information you need.  As I said
above, if you need additional information, just let me know, and I?ll
be happy to assist you further.


search strategy:
Google searches on 
?venous reflux?
schelling sclerosis
(reflux OR back-jet OR backflow) sclerosis
Subject: Re: "Venous reflux: cause of specific findings in multiple sclerosis at p.m./on MRI"
From: till-ga on 30 Oct 2003 04:59 PST
Does the follwing article help you ?

This presentation aims at contributing towards resolving some of the
most burning issues of multiple sclerosis research. Of central
importance is the pathogenic relevance of flow inversions pushing back
into particular venous drainages of the brain or spinal canal. The
author is wholeheartedly convinced that by demonstrating the impact of
these venous flow-inversions and their cerebrospinal fluid
displacements, directly in vivo and/or at post mortem, the relevant
venous anomalies can better be understood and remedied. Any feedback
on the part of the reader would be very highly appreciated, including
critical commentaries which might help to clarify many of the issues
surrounding multiple sclerosis.

You can reach me by sending an email to:"  
Mutiple Sceloris
( )

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