Researchers from the Mayo Clinic confirm my concept of the Midline Congestion Syndrome - Prof. Dr. Thomas Scholbach
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The papers from the Mayo Clinic and from UK/Norway posted on this website can be downloaded and opened for personal use only, my paper is freely usable

 

In 2007 I published my concept of congestion of midline organs due to their involvement in the collateral pathway of the compressed left renal vein.

From the nutcracker-phenomenon of the left renal vein to the midline congestion syndrome as a cause of migraine, headache, back and abdo

In 2022 researchers from the renowned Mayo Clinic, Rochester, USA, independently confirmed the concept by treating patients with intractable headaches with a withdrawal of cerebrospinal fluid and researchers from UK and Norway performed a blockage of the collateral vein connection spanning from the left renal vein towards the spine.

Nutcracker phenomenon with a daily persistent headache as the primary symptom

This lumbar vessel was described by French anatomists as the so-called  tronc réno-rachidièn. This vessel is an important route for sometimes large amounts of blood which enter the spinal canal producing a variety of symptoms.

The pressurization of the spinal canal due to the additional volume provided from the circulation of the left kidney is transferred into the skull due to the connection of the spinal and cerebral compartment at the greater foramen at the base of the skull, the contact point of the first cervical vertebra and the skull.

According to my observations during the last 30 years dealing with this disorder the ensuing symptoms are among others:

  1. Pressure Headaches
  2. Posture dependent headaches
  3. Leakage of cerebrospinal fluid
  4. Migraine
  5. Brain fog
  6. Disturbed memory
  7. Inability to concentrate on mental tasks
  8. Nasal congestion in the morning disappearing in the daytime as soon as the patient is on his/her feet
  9. Teeth grinding at night
  10. Snoring at night
  11. Nocturnal enuresis
  12. Dizziness
  13. Vertigo
  14. Back pain
  15. Weakness of the legs
  16. Progressive paralysis of the legs and later on the arms
  17. Sciatica

 

The researchers from the Mayo Clinic focused on patients with debilitating new onset constant pressure headaches for which no other reason could be found and which did not respond to a variety of medical and other treatment modalities.

They specifically referred to my concept of the Midline Congestion Syndrome and thus looked for a compressed left renal vein in these patients. In the majority of the patients such a left renal vein compression could be demonstrated.

In order to reduce the pressure inside the spinal compartment the patients were treated by lumbar puncture to remove volumes of cerebral spinal fluid from 5 to 20 mL per treatment. The patients became headache free for the first time after this treatment.

One patient was treated with a coiling of the tronc réno-rachidièn (second left lumbar vein) and experienced a complete resolution of her extreme headaches which had lasted on a daily basis for 5 years at a level of 10/10 and did not respond to a great number of medications.

Nutcracker syndrome mimicking new daily persistent headache a case report

Thus, the decompression of the epidural venous plexus and thus the entire spinal compartment resulted in an immediate resolution of one of the main symptoms of the Midline Congestion Syndrome-severe headaches.

Despite the success of the treatment in these patients it seems more favourable from my perspective to treat them by decompression of the left renal vein instead of obstructing a collateral pathway. This closure of the tronc réno-rachidièn in a persistent severe left renal vein compression must result in an increased collateral circulation towards other regions , mainly the pelvic organs. It is thus to be expected that symptoms in the pelvis or legs will increase or the headache will recur due to the development of new collateral pathways which replace the obstructed one.

According to my observation the blood might become trapped in the pelvis due to a coexistent May Thurner syndrome and may then enter the spinal canal again via the left ascending lumbar vein.

I thus recommend a decompression of the left renal vein and the left common iliac vein to treat patient with midline congestion symptoms.

Nevertheless, the approach of the researchers from the Mayo Clinic and those from London and Trondheim is a promising step towards a better understanding and better treatment for many patients, especially women, suffering from this still a little known condition, the Midline Congestion Syndrome due to left renal vein and left iliac vein compression.

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