Dilatation of the Bridging Cerebral Veins in Multiple Sclerosis Correlates with Fatigue and Suggests an Increase in Pressure

Abstract

There is a physiological similarity between the hydrodynamics of hydrocephalus and multiple sclerosis (MS). Children with hydrocephalus have been found to have a significant enlargement of the cortical veins within the subarachnoid space, suggesting an increase in venous pressure. The purpose of this study is to discover if there is dilatation of the veins within the subarachnoid space in multiple sclerosis and to estimate the pressures required to maintain any enlargement found. 103 patients with MS were compared with a control group of 50 patients. Post contrast 3DT1 images were used. The cross-sectional area of the bridging cortical veins and the vein of Galen were measured. In MS, the superficial territory cortical veins were 29% larger and the veins of Galen were 25% larger than the controls. There is evidence of a significant increase in the bridging vein transmural pressure in MS, estimated to be approximately 6.5 mmHg in the superficial cortical veins. MS patients with significant fatigue have larger cortical veins than those who are not significantly fatigued.

Chronic Fatigue Syndrome and Multiple Sclerosis have Reduced Craniospinal Compliance and Dilated Pressurized Bridging Cortical Veins: A Hypothesis Illustrated with Two Case Studies

“…It was found to average 21.9± 4.2 mm 2 [19]. The average of the four largest cortical veins draining into the SSS for the controls averaged 5.8± 1.8 mm 2 [19]. It can be seen that in case 1 the SSS, straight sinus and cortical vein average are greater than two standard deviations above the mean size for the controls.…”

“…The bridging vein between the deep venous system of the brain and the straight sinus is the vein of Galen. It was found to average 21.9± 4.2 mm 2 [19]. The average of the four largest cortical veins draining into the SSS for the controls averaged 5.8± 1.8 mm 2 [19].…”

“…An increase in sinus wall stiffness or thickness would render the craniospinal compartment less compliant than normal. Further study has shown that in MS, the superficial territory cortical veins are 29% larger and the veins of Galen are 25% larger than in the controls [19]. Modelling of these findings indicated that to bring this dilatation about, a significant increase in the bridging vein transmural pressure would be required, estimated to be approximately 6.5 mmHg [19] .…”

“…Further study has shown that in MS, the superficial territory cortical veins are 29% larger and the veins of Galen are 25% larger than in the controls [19]. Modelling of these findings indicated that to bring this dilatation about, a significant increase in the bridging vein transmural pressure would be required, estimated to be approximately 6.5 mmHg [19] . Finally, MS patients with significant fatigue have larger cortical veins than those who are not significantly fatigued [19].…”

“…Modelling of these findings indicated that to bring this dilatation about, a significant increase in the bridging vein transmural pressure would be required, estimated to be approximately 6.5 mmHg [19] . Finally, MS patients with significant fatigue have larger cortical veins than those who are not significantly fatigued [19]. These findings lead us to suggest a hypothesis for the underlying physiology of CFS.…”