Chronic cerebrospinal venous insufficiency is unlikely to be a direct trigger of multiple sclerosis

Simka, Marian; Ludyga, Tomasz; Latacz, Paweł; Kazibudzki, Marek; Majewski, Eugeniusz; Zaniewski, Maciej

doi:10.1016/j.msard.2013.02.004

Cited by 8 publications

(6 citation statements)

References 29 publications

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“…The concept of CCSVI proposed by the Zamboni group 1 as a causal factor in development of MS is controversial. [26][27][28][29][30] While the Zamboni data purporting to show differences in venous haemodynamics in patients with MS compared to control subjects can be challenged on methodological grounds, in particular because sonographers were unblinded, the concepts of anatomic organisation of venous drainage of the brain and venous shunting 31 and protocols developed for ultrasound assessment and interpretation 10 are intriguing. Unfortunately, the criteria for abnormality appear arbitrary and validation studies are limited.…”

Section: Discussionmentioning

confidence: 99%

Internal jugular and vertebral vein volume flow in patients with clinically isolated syndrome or mild multiple sclerosis and healthy controls: results from a prospective sonographer-blinded study

Chambers

Чурилов

et al. 2013

Phlebology

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Section: Discussionmentioning

confidence: 99%

Internal jugular and vertebral vein volume flow in patients with clinically isolated syndrome or mild multiple sclerosis and healthy controls: results from a prospective sonographer-blinded study

Chambers

Чурилов

et al. 2013

Phlebology

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“…Still, an association of CCSVI with MS was not confirmed by many authors, probably not only because of the different diagnostic protocols used, but primarily due to much a more complex relationship between CCSVI and MS than was initially believed [18].…”

Section: Discussionmentioning

confidence: 97%

Hypercapnia and hypoxaemia due to impaired venous blood draining and significant improvement after endovascular treatment in patients with chronic cerebrospinal venous insufficiency

Petrov¹,

Grozdinski²,

Tsonev³

et al. 2016

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Objectives: The aim of this prospective study was to investigate if venous blood coming from the brain and spinal cord in multiple sclerosis patients contains abnormal concentrations of oxygen and carbon dioxide and whether blood gas parameters normalise after successful endovascular angioplasty of abnormal veins. Material and methods: In this study 178 multiple sclerosis patients with sonographically-proven chronic cerebrospinal venous insufficiency and 50 controls without multiple sclerosis and venous abnormalities were included. We obtained blood samples from the femoral, internal jugular, and azygous veins and measured: partial pressure of oxygen (pO 2 ), partial pressure of carbon dioxide (pCO 2 ), and oxygen saturation (SatO 2 ). In multiple sclerosis patients these blood gas parameters were evaluated before and after endovascular treatment for chronic cerebrospinal venous insufficiency. Results: Blood samples obtained from the internal jugular veins in multiple sclerosis patients revealed significant hypercapnia and hypoxaemia. Blood from the azygous veins in these patients revealed hypercapnia, but not hypoxaemia. After endovascular treatment of the stenoses most of the abnormal blood gas parameters improved significantly: in the internal jugular veins -all parameters studied, while in the azygous vein -pCO 2 and pO 2 improved but SatO 2 remained unchanged. Conclusions:We demonstrated hypercapnia and hypoxaemia in the veins draining the brain and spinal cord in multiple sclerosis patients, and improvement of blood gas parameters after endovascular treatment for chronic cerebrospinal venous insufficiency. Nevertheless, it is unclear if this beneficial effect is long lasting and has any influence on the natural course of multiple sclerosis.

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“…Atypical structured jugular valves can be found in some healthy individuals, but these are primarily present in patients suffering from neuroinflammatory and neurodegenerative diseases [ 36 , 37 , 38 ]. Although some clinicians claimed a causative role for such aberrant jugular valves in neurological disorders, such an association has not been unequivocally proved [ 39 ]. The current consensus is that a majority of abnormal jugular valves represent congenital pathology, the so-called truncular malformations [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Results of Numerical Modeling of Blood Flow in the Internal Jugular Vein Exhibiting Different Types of Strictures

Rashid

Iqrar²,

Rashid³

et al. 2022

Diagnostics

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The clinical relevance of nozzle-like strictures in upper parts of the internal jugular veins remains unclear. This study was aimed at understanding flow disturbances caused by such stenoses. Computational fluid dynamics software, COMSOL Multiphysics, was used. Two-dimensional computational domain involved stenosis at the beginning of modeled veins, and a flexible valve downstream. The material of the venous valve was considered to be hyperelastic. In the vein models with symmetric 2-leaflets valve without upstream stenosis or with minor 30% stenosis, the flow was undisturbed. In the case of major 60% and 75% upstream stenosis, centerline velocity was positioned asymmetrically, and areas of reverse flow and flow separation developed. In the 2-leaflet models with major stenosis, vortices evoking flow asymmetry were present for the entire course of the model, while the valve leaflets were distorted by asymmetric flow. Our computational fluid dynamics modeling suggests that an impaired outflow from the brain through the internal jugular veins is likely to be primarily caused by pathological strictures in their upper parts. In addition, the jugular valve pathology can be exacerbated by strictures located in the upper segments of these veins.

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Chronic cerebrospinal venous insufficiency is unlikely to be a direct trigger of multiple sclerosis

Cited by 8 publications

References 29 publications

Internal jugular and vertebral vein volume flow in patients with clinically isolated syndrome or mild multiple sclerosis and healthy controls: results from a prospective sonographer-blinded study

Internal jugular and vertebral vein volume flow in patients with clinically isolated syndrome or mild multiple sclerosis and healthy controls: results from a prospective sonographer-blinded study

Hypercapnia and hypoxaemia due to impaired venous blood draining and significant improvement after endovascular treatment in patients with chronic cerebrospinal venous insufficiency

Results of Numerical Modeling of Blood Flow in the Internal Jugular Vein Exhibiting Different Types of Strictures

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