Possible Markers of Venous Sinus Pressure Elevation in Multiple Sclerosis: Correlations with Gender and Disease Progression

Abstract

Background: In a previous study, multiple sclerosis (MS) was found to be associated with an increase in intracranial arterial pulsation volume and a reduction in venous sinus compliance, affecting pulsation dampening. There was a suggestion that the reduction in compliance of the sagittal sinus in MS was caused by an increase in venous pressure, secondary to transverse sinus stenosis. Some differences were noted depending on the gender of the patients, however, the original study was relatively underpowered for further sub-classification. The purpose of the current study is to enroll a larger number of patients to allow sub-classification on gender and disease type to further evaluate the markers of possible venous pressure alteration. Methods: 103 patients with MS were prospectively recruited from an MS clinic and compared to 50 matched non-MS patients. Using 3DT1 post contrast images, the sagittal sinus cross-sectional area was measured. The narrowest portion of the transverse sinuses was located and the cross sectional areas and wetted circumferences were measured to calculate the minimum hydraulic and effective diameters. The jugular bulb heights were measured. Voxel wise brain morphometry was performed to evaluate atrophy. Statistical analysis was performed using non-parametric methods and was assessed using α≤0.05.Results: Compared to controls, the MS patients' sagittal sinuses were 23% larger in cross-section (p<0.0001), the transverse sinuses had an average effective stenosis of 39% by area (p<0.0001) and there was a 62% increase in jugular bulb height (p=0.0001). The MS patients showed a reduction in normalized grey matter volume of 2.8% (p= 0.0001). Males with MS showed worse outcomes compared to females, with an increased EDSS and grey matter loss and had a 23% larger sagittal sinus area (p=0.02), 22% higher jugular bulb height (p=0.03) but a lower transverse sinus stenosis percentage (19% vs 48%, p<0.0001). Progressive forms of MS also had worse outcomes and had a 19% larger sagittal sinus area (p=0.04) compared to relapsing remitting MS. Conclusion:In this larger cohort, worse outcomes in both males and progressive forms of MS were associated with larger sagittal sinuses. The possible cause of the altered sinus pressure in females was narrower transverse sinuses. In males, higher jugular bulbs may be associated with increased venous sinus pressure.

Biomechanical changes of the common carotid artery and internal jugular vein in patients with multiple sclerosis

“…In the current study, a significant raise in the IJV's pressure in patients with MS compared to healthy individuals was observed. Increasing venous pressure in the superior sagittal sinus in MS A c c e p t e d A r t i c l e patients has been also reported by Bateman et al [24,25]. In this study, the radial strain of the CCA wall in patients with RRMS and PPMS was reduced by 38% and 25%, respectively.…”

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

“…If the pressure across the sinus wall remains normal at 4 mmHg, then the sagittal sinus pressure in MS would be mildly increased by 1.5 mmHg. This mild increase in sinus pressure would correlate with the 39% average stenosis of the transverse sinuses and 62% increase in jugular bulb height in MS 20 . A previous modelling study indicated a 38% stenosis would increase the venous pressure by 0.7 mmHg in the sagittal sinus 21 .…”

“…One hundred and three MS patients were prospectively recruited from an MS outpatient clinic at a tertiary referral hospital. These patients were part of a previous study 20 . There were 79 females and 24 males of average age 47.8± 13.0 years.…”

Modelling of the dilated sagittal sinuses found in multiple sclerosis suggests increased wall stiffness may be a contributing factor

“…Sixteen percent of MS patients have a high grade stenosis of the transverse sinuses which could account for the change in sinus wall deflection 3 . However, the average transverse sinus in MS patients has been found to have a 39% effective stenosis in area and there was a 62% increase in jugular bulb height 2 , with both of these findings suggested to increase venous pressure. We are unable to estimate the change in pressure due to a change in bulb height.…”

“…In multiple sclerosis (MS) the superior sagittal sinus (SSS) cross-sectional area was found to be 16% larger than in matched controls 1 . The sinus size seems to have prognostic significance with larger sinuses correlating with male patients, progressive forms of the disease and worsening outcomes 2 . It was noted that in hydrocephalus and spontaneous intracranial hypotension, the cross-sectional area of the SSS varies with the pressure difference between the sinus and the subarachnoid space (the transmural pressure) 1 .…”