{"id":4568,"date":"2025-09-01T06:09:05","date_gmt":"2025-09-01T06:09:05","guid":{"rendered":"https:\/\/www.raffaellopagani-ccsvi.it\/?p=4568"},"modified":"2025-08-25T18:21:42","modified_gmt":"2025-08-25T18:21:42","slug":"ccsvi-and-fnd","status":"publish","type":"post","link":"https:\/\/www.raffaellopagani-ccsvi.it\/en\/ccsvi-and-fnd\/","title":{"rendered":"Functional Neurological Disorder and CCSVI: When Medicine Stops Looking"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"4568\" class=\"elementor elementor-4568 elementor-4464\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7ed66ec e-flex e-con-boxed e-con e-parent\" data-id=\"7ed66ec\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-13d8e16 elementor-widget elementor-widget-text-editor\" data-id=\"13d8e16\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h3>When One Answer Isn\u2019t Enough<\/h3><p>In recent years, many patients presenting with severe and debilitating neurological symptoms\u2014headaches (both supine and orthostatic), seizure-like episodes, dizziness, visual disturbances, sudden hearing loss, pulsatile or constant tinnitus, and sudden weakness\u2014have often been told the same phrase: <strong>\u201cThis is a functional neurological disorder (FND).\u201d<\/strong><\/p><p>At first glance, it may sound like an answer. In reality, for many it becomes a sentence: being labeled as \u201cfunctional\u201d patients, trapped in a limbo between neurology and psychiatry &#8211; often without any further investigation. A diagnosis that closes doors rather than opening them.  <\/p><p>The problem is that some of these patients are not suffering from a functional disorder at all, but from an overlooked organic condition: <strong>CCSVI (Chronic Cerebrospinal Venous Insufficiency)<\/strong>.<br>The risk is enormous: mistaking a real vascular problem for a \u201cpsychogenic\u201d disorder means not only missing the correct diagnosis, but also allowing symptoms to worsen\u2014with potentially irreversible consequences.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1bbdbb5 elementor-widget elementor-widget-themeht-heading\" data-id=\"1bbdbb5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"themeht-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n        <div class=\"\">\r\n\r\n          <h2 class=\" \">Functional Neurological Disorder: From Definition to Label<\/h2>       \r\n\r\n        <\/div>\r\n\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d8c7fca elementor-widget elementor-widget-text-editor\" data-id=\"d8c7fca\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>FND is described as a disorder of nervous system function in the absence of visible organic lesions. The symptoms are real, not imagined, but their origin is considered non-structural. <\/p><p>Among the most common manifestations:<\/p><ul><li>tremors, tics, and abnormal movements<\/li><li>non-organic weakness or paralysis<\/li><li>psychogenic seizure-like episodes<\/li><li>visual disturbances, dizziness, loss of balance<\/li><li>altered sensation<\/li><\/ul><p>In theory, the diagnosis should be <strong>based on positive clinical signs<\/strong> and not merely on ruling out other conditions. In practice, however, FND is often used as a convenient label: when CT scans and MRIs show nothing, the problem is simply deemed \u201cfunctional.\u201d  <strong>And this doesn\u2019t happen only in Italy: it\u2019s a widespread trend across the world, with patients everywhere being dismissed with this diagnosis without further investigation.<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-368f946 elementor-widget elementor-widget-text-editor\" data-id=\"368f946\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>A review published in <em>Practical Neurology<\/em> (<a title=\"Edwards &amp; Bhatia, 2021 \u2013 PubMed\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33479065\/\" target=\"_blank\" rel=\"noopener\"><span style=\"text-decoration: underline;\"><strong>Edwards &amp; Bhatia, 2021 \u2013 PubMed<\/strong><\/span><\/a>) highlights that FND is common in emergency departments and neurology wards, but also acknowledges how often the diagnosis is poorly communicated &#8211; leaving patients stigmatized.<\/p><p>The result is that, in clinical practice, FND risks becoming a <strong>diagnostic wastebasket<\/strong>: everything that isn\u2019t understood ends up in it.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-643d2b7 elementor-widget elementor-widget-themeht-heading\" data-id=\"643d2b7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"themeht-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n        <div class=\"\">\r\n\r\n          <h2 class=\" \">CCSVI: An Overlooked Organic Cause<\/h2>       \r\n\r\n        <\/div>\r\n\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cf198a0 elementor-widget elementor-widget-text-editor\" data-id=\"cf198a0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>CCSVI<\/strong> was first described in 2006 as a vascular condition characterized by abnormalities in cerebrospinal venous outflow, caused by stenosis of the jugular veins (defective valves, hypoplasia, aplasia, or other vascular malformations). Later studies also identified extrinsic compressions of the jugular veins by surrounding structures &#8211; bones, muscles, ligaments, and nearby arteries.<\/p><p>The consequences are physiopathologically logical:<\/p><ul><li>venous stasis<\/li><li>cerebral hypoxia<\/li><li>altered cerebrospinal fluid drainage<\/li><li>increased intracranial pressure<\/li><li>chronic inflammation<\/li><\/ul><p>And the symptoms? The very same ones that are often dismissed today as FND: orthostatic headache, brain fog, seizure-like episodes, dizziness, visual disturbances, and dysphagia. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9f0d902 elementor-widget elementor-widget-text-editor\" data-id=\"9f0d902\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><a title=\"What is CCSVI?\" href=\"https:\/\/www.raffaellopagani-ccsvi.it\/en\/department\/ccsvi-cerebrospinal-venous-insufficiency\/\" target=\"_blank\" rel=\"noopener\"><span style=\"text-decoration: underline;\"><strong>\ud83d\udc49 CCSVI: Diagnosis and Symptoms<\/strong><\/span><\/a><\/p><p>The crucial point is that CCSVI <strong>does not always show up on standard tests<\/strong>: an MRI taken supine, in a neutral frontal position, may appear completely normal, while the problem only becomes evident under dynamic or postural conditions.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3caa9cc elementor-widget elementor-widget-themeht-heading\" data-id=\"3caa9cc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"themeht-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n        <div class=\"\">\r\n\r\n          <h2 class=\" \">When Standard Tests Aren\u2019t Enough: The Posture Factor<\/h2>       \r\n\r\n        <\/div>\r\n\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bf1583d elementor-widget elementor-widget-text-editor\" data-id=\"bf1583d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Medicine is accustomed to working with \u201cclassic\u201d protocols: MRI performed in the supine position, EcoColorDoppler done supine or upright at 90 degrees in a neutral frontal position\u2014static tests that do not reflect real-life conditions.<\/p><p>But cerebral and spinal venous flow is highly <strong>dynamic<\/strong> and strongly influenced by posture.<br>A patient lying flat at 0 degrees may show <strong>obstructions, flow reversals, or venous collapses<\/strong>, while the very same patient evaluated in an upright 90-degree position may reveal these pathologies\u2014or even display completely normal venous return.<\/p><p><strong>It has been shown that jugular compressions cannot be reliably detected in just one postural state or in a single neutral head position.<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8d8fd77 elementor-widget elementor-widget-text-editor\" data-id=\"8d8fd77\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>For CCSVI, performing dynamic tests is essential:<\/p><ul><li>EcoColorDoppler in both upright and supine positions, with the head in a neutral frontal position and during dynamic head maneuvers<\/li><li>Selective venography with postural variations<\/li><li>CBCT to study bone compressions, both static and dynamic<\/li><li>Evaluations during maneuvers such as Valsalva or neck rotations<\/li><\/ul><p>This methodological difference can mark the boundary between an accurate diagnosis of CCSVI and a hasty diagnosis of a functional disorder.<\/p><p>And yet, most physicians don\u2019t go beyond standardized tests. They stop there and hand the patient a reductive label. This is a cultural and clinical limitation that must be called out.  <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8069626 elementor-widget elementor-widget-themeht-heading\" data-id=\"8069626\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"themeht-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n        <div class=\"\">\r\n\r\n          <h2 class=\" \">FND as a Diagnostic Alibi<\/h2>       \r\n\r\n        <\/div>\r\n\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a80a99a elementor-widget elementor-widget-text-editor\" data-id=\"a80a99a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Many neurologists defend FND as a modern and \u201cpositive\u201d diagnosis. But in daily practice, it all too often becomes an alibi &#8211; used to justify the lack of answers, rather than admitting that perhaps the tools being used are simply not enough. <\/p><p>The patient, meanwhile, doesn\u2019t receive an explanation but a stigma: \u201cit\u2019s functional, not organic.&#8221;<br>A label that pushes them toward psychotherapy, while the real cause goes unnoticed.<\/p><p>This does not mean denying that functional disorders exist. It means calling out the fact that, in far too many cases, FND is used as a <strong>lazy diagnosis<\/strong> &#8211; one that closes doors instead of opening them. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-baba4b1 elementor-widget elementor-widget-themeht-heading\" data-id=\"baba4b1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"themeht-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n        <div class=\"\">\r\n\r\n          <h2 class=\" \">Patient Testimonies<\/h2>       \r\n\r\n        <\/div>\r\n\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1dd2b61 elementor-widget elementor-widget-text-editor\" data-id=\"1dd2b61\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The stories are strikingly similar:<\/p><ul><li>years of debilitating, progressive symptoms<\/li><li>standard tests reported as \u201cnormal\u201d<\/li><li>a diagnosis of FND<\/li><li>years of psychotherapy and anxiolytic medications with no benefit<\/li><li>finally, targeted venous investigations and a diagnosis of CCSVI<\/li><li>clinical improvement after treatment (physiatry, osteopathy, chiropractic care, angioplasty, surgical decompression)<\/li><\/ul><p>These testimonies expose the failure of an exclusively neurological approach. They are not isolated cases but a recurring pattern that deserves scientific attention. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-da784e0 elementor-widget elementor-widget-themeht-heading\" data-id=\"da784e0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"themeht-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n        <div class=\"\">\r\n\r\n          <h2 class=\" \">The Wound of Stigma<\/h2>       \r\n\r\n        <\/div>\r\n\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2cfeddf elementor-widget elementor-widget-text-editor\" data-id=\"2cfeddf\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Receiving an FND diagnosis means being told: \u201cyour symptoms are real, but they have no organic basis.\u201d<br>In other words, it is often perceived as: \u201cit\u2019s all in your head.\u201d<\/p><p>The consequences are devastating:<\/p><ul><li>loss of trust in medicine<\/li><li>social isolation<\/li><li>loss of credibility even within the family<\/li><li>abandonment of care and despair<\/li><\/ul><p>And yet, behind those symptoms there may be an objective, diagnosable, and treatable condition such as CCSVI.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-584c242 elementor-widget elementor-widget-themeht-heading\" data-id=\"584c242\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"themeht-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n        <div class=\"\">\r\n\r\n          <h2 class=\" \">CCSVI and Controversy: A Divided Science<\/h2>       \r\n\r\n        <\/div>\r\n\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-03595d1 elementor-widget elementor-widget-text-editor\" data-id=\"03595d1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>From the very beginning, CCSVI has faced strong opposition, especially from the neurology community, due to its initial proposed link with multiple sclerosis. Nevertheless, numerous studies have been published in the literature reporting varying percentages of CCSVI among patients with multiple sclerosis.<\/p><p>Several studies, such as the one by Zamboni and colleagues published in <em>BMC Medicine<\/em> (2013), have nevertheless documented venous abnormalities with potential clinical consequences.<\/p><p>The scientific community remains divided. But to completely ignore CCSVI and retreat into an FND diagnosis is to <strong>deny the complexity of clinical reality<\/strong>. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cab31df elementor-widget elementor-widget-themeht-heading\" data-id=\"cab31df\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"themeht-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n        <div class=\"\">\r\n\r\n          <h2 class=\" \">The Responsibility of Medicine<\/h2>       \r\n\r\n        <\/div>\r\n\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b060a08 elementor-widget elementor-widget-text-editor\" data-id=\"b060a08\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The task of medicine is not to settle for what is simple, but to search for the truth. Labeling a patient as \u201cfunctional\u201d without carefully ruling out other organic causes\u2014including venous ones\u2014is not just a clinical mistake. It is an act that betrays the patient\u2019s trust. <\/p><p>What we need are broader protocols\u2014ones that integrate classical neurological evaluation with dynamic venous testing. We need physicians willing to look beyond the limits of standard literature. <\/p><p>Only in this way can we prevent an FND diagnosis from becoming a lazy and harmful shortcut.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3a4859c elementor-widget elementor-widget-themeht-heading\" data-id=\"3a4859c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"themeht-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n        <div class=\"\">\r\n\r\n          <h2 class=\" \">Looking Beyond the Label<\/h2>       \r\n\r\n        <\/div>\r\n\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6249f69 elementor-widget elementor-widget-text-editor\" data-id=\"6249f69\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Functional neurological disorder<\/strong> does exist, but today it is overused. It has become the easy label for those who find nothing in standard tests.<br><strong>CCSVI<\/strong> is a concrete example of how real symptoms are dismissed as \u201cfunctional,\u201d when in fact there are precise, organic causes\u2014diagnosable and treatable. <\/p><p>Medicine must not stop searching.<br>Every time the quick route is chosen\u2014the functional label\u2014there is a risk of extinguishing the hope of those who suffer.<\/p><p>Every patient deserves concrete answers, not labels. For this reason, I invite you, if you wish, to <span style=\"text-decoration: underline;\"><strong><a title=\"Contacts\" href=\"https:\/\/www.raffaellopagani-ccsvi.it\/en\/contacts-vascular-surgery-ccsvi\/\" target=\"_blank\" rel=\"noopener\">book a consultation with me at my practice for a personalized CCSVI evaluation<\/a><\/strong><\/span>. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Too many CCSVI patients are misdiagnosed with functional neurological disorder\u2014an error that overlooks real organic causes and delays treatment<\/p>\n","protected":false},"author":1,"featured_media":4521,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[140],"tags":[170,109,147,349,885,546,348,888,891,883,890,884,171,886,889,887],"class_list":["post-4568","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ccsvi-en","tag-brain-fog-en","tag-ccsvi-en","tag-ccsvi-treatment","tag-cerebral-venous-system","tag-chronic-cerebrospinal-venous-insufficiency","tag-compressione-giugulare-en","tag-differential-diagnosis","tag-dynamic-doppler","tag-fnd-en","tag-functional-neurological-disorder","tag-medical-stigma","tag-misdiagnosis","tag-orthostatic-headache","tag-seizure-like-episodes","tag-selective-venography","tag-venous-instability"],"acf":[],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 4.9.10 - aioseo.com -->\n\t<meta name=\"description\" content=\"Too many CCSVI patients are misdiagnosed with functional neurological disorder\u2014an error that overlooks real organic causes and delays treatment\" \/>\n\t<meta name=\"robots\" content=\"max-image-preview:large\" \/>\n\t<meta name=\"author\" content=\"Dott. 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