Chronic cerebrospinal venous insufficiency

Barreto, Andrew D; Brod, Staley A.; Bui, Tuan Anh; Jemelka, James R.; Kramer, Larry A.; Ton, K.; Cohen, Alan M.; Lindsey, J. W.; Nelson, Flavia; Narayana, Ponnada A.; Wolinsky, Jerry S.

doi:10.1002/ana.23839

Cited by 23 publications

(13 citation statements)

References 14 publications

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“…These results are in line with previous findings of high variability of incidence of IJV stenosis on MS and, in particular, in HC. 8,9,21,26 Our results confirm that the occurrence of IJV stenosis in MS is not common enough to be defined as a feature of the disease; in addition, the high incidence of IJV stenosis in HC confirms that stenosis is related to a physiological variability rather than to a pathological condition. As a further validation of our result, a recent study 29 investigating the prevalence of incidental superior IJV narrowing in patients imaged AV-mismatch, arteriovenous mismatch; dIJVF, dominant internal jugular vein flow rate; IJV, internal jugular vein; nIJV, normalized internal jugular vein; SD, standard deviation; sdIJVF, subdominant internal jugular vein flow rate.…”

Section: Discussionsupporting

confidence: 60%

“…2 Among the potential factors that were related to MS, abnormal venous haemodynamics in the neck, including venous reflux and stenosis, has been hypothesized to be a feature of MS. [3][4][5][6] During the past few years, different studies were carried out to investigate the possible role of extracranial venous flow abnormalities in MS. These studies used different image modalities such as ultrasound 3,5,[7][8][9][10][11][12][13][14] and MRI, including contrast-enhanced MR venography (CE-MRV), phasecontrast MRI or time-of-flight sequences, 4,[15][16][17][18][19][20] and a combination of different imaging modalities. [21][22][23][24][25][26] These studies, however, yielded somewhat conflicting results, and the role of venous abnormalities in MS still remains in discussion.…”

Section: Introductionmentioning

confidence: 99%

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Lack of correlation between extracranial venous abnormalities and multiple sclerosis: a quantitative MRI study

Cocozza¹,

Canna²,

Lanzillo³

et al. 2016

BJR

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Sirio Cocozza and Antonietta Canna contributed equally to this work. Giuseppe Palma and Enrico Tedeschi share senior authorship.Objective: We aimed to evaluate the presence of venous stenosis and blood flow abnormalities in the neck vessels of patients with multiple sclerosis (MS), in respect to a group of age-and sex-matched healthy controls (HC), and their possible relations with clinical variables using a semi-automated quantitative MRI method. Methods: 45 patients with relapsing remitting MS and 40 HC were enrolled in this study. Flow rates and crosssectional areas of arterial and venous neck vessels were assessed by phase-contrast MRI at two different neck levels (C2-C3 and C6-C7), and differences between groups were evaluated with an unpaired t-test. Correlation between blood flow variables and clinical parameters was analyzed with Spearman's test. Results: A significant internal jugular vein (IJV) stenosis was found in 23/45 (51.1%) patients with MS and 18/40 (45.0%) HC. No differences were observed between patients with MS and HC for any of the flow measures obtained. No correlations were found between MRI measures and any of the tested clinical variables. Conclusion: No differences in the IJV area emerged at quantitative MRI evaluation, suggesting that stenosis of the extracranial veins is unrelated to MS. Furthermore, no flow differences in the neck vessels were found between patients with MS and HC in any of the tested flow measures, with no correlation with clinical variables. Our results confirm that the hypothesis of the presence of extracranial venous abnormalities in MS, both in terms of stenosis or flow measures, is not suitable. Advances in knowledge: Neck venous drainage abnormalities have been claimed to be associated with MS. Conversely, our quantitative MRI analysis seems to exclude that extracranial venous alterations are related to the disease.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Lack of correlation between extracranial venous abnormalities and multiple sclerosis: a quantitative MRI study

Cocozza¹,

Canna²,

Lanzillo³

et al. 2016

BJR

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“…This invalidates the hypothesised correlation between patients with MS and impaired cerebrospinal venous outflow. These results are in line with the outcomes of multiple studies worldwide in which no relation between impaired cerebrospinal venous outflow and MS was found [20,21,22,23,24,25,26,27]. It is also in agreement with the outcome of the large cohorts investigated so far, the observational study of the prevalence of CCSVI in MS and in other neurodegenerative diseases (CoSMo study) [28].…”

Section: Discussionsupporting

confidence: 90%

Cerebrospinal Venous Outflow in Multiple Sclerosis Patients versus Fatigue and/or Depression

et al. 2013

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Background: Endovascular treatment of impaired cerebrospinal venous outflow has been suggested to improve the overall quality of life in multiple sclerosis (MS) patients. Fatigue and depression are key factors in measuring the quality of life in MS patients. Objective: In the present study, we investigated the correlation between anomalous venous outflow and the seriousness of fatigue and depression in MS patients and healthy controls. Methods: Five cerebrospinal venous outflow parameters were measured in 20 MS patients and age- and sex-matched controls using extra- and transcranial Colour Doppler sonography. All patients and volunteers filled out the Fatigue Severity Scale (FSS) and Hospital Anxiety Depression Subscale (HADS). Results: Nine abnormal parameters were found in 8 MS patients, whereas five abnormal parameters were found in 3 healthy controls (no significant difference). Only 1 MS patient met the criteria for chronic cerebrospinal venous insufficiency compared to 2 healthy controls. No significant differences were found in the FSS and HADS scores between patients with and without abnormal cerebrospinal venous outflow parameters. Conclusions: We found no significantly impaired cerebrospinal venous outflow in patients with MS versus sex- and age-matched controls. Furthermore, we did not find any correlation between anxiety or depression and impaired venous outflow in MS patients.

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“…Zamboni’s criteria were met by 13 patients, including 8 patients with MS and 5 patients with disorders other than MS [19]. …”

Section: Results Of Studies Conducted To Datementioning

confidence: 99%

Is there any relation between chronic cerebrospinal venous insufficiency and multiple sclerosis? – a critical review

Jedynak

Cieszanowski

2014

Pol J Radiol

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SummaryThough the etiology of multiple sclerosis remains unknown, the widely accepted explanation is that it has an autoimmune inflammatory background. In 2006 Paolo Zamboni renewed the somewhat forgotten vascular theory of the pathogenesis of multiple sclerosis, proposing the new entity of ‘chronic cerebrospinal venous insufficiency’.As a result of this hypothesis, Zamboni suggested an endovascular treatment for multiple sclerosis involving venoplasty of the internal jugular vein and the azygos vein. Unfortunately, several teams have tried to replicate Zamboni’s results without success. In this review, we present a chronological description of the results of the studies conducted by Zamboni and the later attempts to replicate his work. The main conclusion is that, taking into account results that are currently available, we should remain cautious and routine use of this treatment in patients should not be advisable.

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Chronic cerebrospinal venous insufficiency

Cited by 23 publications

References 14 publications

Lack of correlation between extracranial venous abnormalities and multiple sclerosis: a quantitative MRI study

Lack of correlation between extracranial venous abnormalities and multiple sclerosis: a quantitative MRI study

Cerebrospinal Venous Outflow in Multiple Sclerosis Patients versus Fatigue and/or Depression

Is there any relation between chronic cerebrospinal venous insufficiency and multiple sclerosis? – a critical review

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