Age-related Vascular Differences among Patients Suffering from Multiple Sclerosis

Abstract

The aim of our study was to analyze morphological and functional aspects of cerebral veins by means of ecocolor-Doppler in young (i.e., ≤ 30 years old) and older (i.e., >30 years old) patients suffering from multiple sclerosis. 552 multiple sclerosis patients were evaluated by means of a dedicated Echo-Color-Doppler support (MyLab Vinco echocolor Doppler System, Esaote), in both supine and sitting positions. 458 (83%) showed alterations in their morphological and functional structures of cerebral veins and were divided in two different groups: 1) ≤ 30 (110 patients) and 2)>30 years old (348 patients). Young patients showed a statistically significant higher number of both hemodynamically (44% vs. 35%, p<0.01) and non-hemodynamically (51% vs. 45%, p<0.05) significant stenosis in the internal jugular veins as compared to older patients. A lower percentage of young patients showed blocked outflow in the cervical veins (50% vs. 65%, p<0.01) as compared to older ones. Patients >30 years old outlined a significantly higher disability degree (Expanded Disability Status Scale score: 5 vs. 3, p<0.01) as well as higher disease duration (12 vs. 5 months, p<0.01) than younger. No differences could be outlined about multiple sclerosis clinical form of the disease. It was evidenced that young and adult groups are different kind of patients, the former showing much more cerebral veins stenosis and blocked flow in internal jugular veins and vertebral veins than the latter. Duration of disease could explain such differences: the higher the diseases duration, the higher the degree of vascular alterations and, therefore, the disability degree. This could be due to the complex venous hemodynamic impairments induced by alterations in vascular walls: the blocked or difficult blood flow through stenosis could increase the hydrostatic pressure in the skull and this could induce damages to cerebral cells leading to the genesis of more advanced morphological abnormalities. Furthermore, the vessels' alterations could impair venous endothelial functions which could turn in a possible alteration of the controls of cerebral vein return which could worsen the cerebral vascular outflow. It may be possible that early clinical, pharmacological and/or invasive vascular interventions could exert a possible role in the natural history of multiple sclerosis. Nevertheless, further trials are needed in order to confirm such considerations.

A Current Understanding of Alzheimers Disease and the Prospects of Phytopharmacological Intervention as a Management Strategy

“…It is possible that this is also the cause of neurodegeneration in AD. A recent finding on evaluation of MS which is similar to AD suggests that age may be a significant contribution to the disease development of MS [19,20,22]. Moreover, it is demonstrated that the longer the duration of the disease, the higher the damage of the vascular tissues and hence the greater the degree of disability [19].…”

“…The younger patients aged 30 years and lower, show cerebral veins stenosis and blocked flow of blood in internal jugular veins and vertebral veins compared to the older patients aged 30 years and above. It was established that only the duration of the disease can be able to explain the disease differences [19].…”

“…In addition, it is possible that the change in the hemodynamic profiles of the venous system interferes with the endothelial functions of the veins. This has also been implicated in the destruction of the cerebral vein return affecting the control of the function of the cerebral vascular blood outflow [19].…”

“…Advanced medical imaging's can also be done using Computer Tomography (CT), magnetic resonance imaging (MRI), and Single Photon Emission Computed Tomography (SPECT) and sometimes, Positron Emission Tomography (PET) can be used in the determination of the precise medical conditions and excluding other extreme forms of cerebral pathology. CCSVI has been evaluated using ECD, UDC, UDS, TCCS, and even MRI [19]. Intellectual functions may also be assessed by memory testing which is the main characteristic of AD [20].…”

“…Many studies have applied the use of Echo-color-Doppler technique in measuring the degree of venous vascular degeneration of loss of endothelial capacity associated with the development of CCSVI [19,46]. While CCSVI syndrome is related to MS [46], there is significant potential that this may also be responsible for the change of clinical symptoms in patients with AD since they all develop neurodegeneration as a common clinical condition.…”