Potential involvement of the extracranial venous system in central nervous system disorders and aging

Zivadinov, Robert; Chung, Chih‐Ping

doi:10.1186/1741-7015-11-260

Cited by 71 publications

(80 citation statements)

References 185 publications

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“…The extra-jugular drainage system consists of the vertebral venous system, the deep cervical veins (DCV) which anatomically are paraspinal towards the heart, and the anterior and external jugular veins (AJV and EJV), which receive blood from facial and superficial areas 8 . Although the presence and structure of collateral veins has been assessed using TRICKS venography, flow values were not quantitatively evaluated 9–11 .…”

Section: Introductionmentioning

confidence: 99%

Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow

Sethi

Daugherty

Gadda

et al. 2017

AJNR Am J Neuroradiol

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Background and Purpose To date, research on extracranial venous collaterals has been focused on structure, with relatively little attention paid to hemodynamics. We address this limitation by quantitatively comparing collateral flow in multiple sclerosis (MS) patients and healthy controls (HC) using Phase-Contrast (PC) MRI. We hypothesize that MS patients with structurally anomalous internal jugular veins (IJVs) will have elevated collateral venous flow compared to HC. Methods The sample consisted of 276 MS patients and 106 HC. We used MRV to classify IJVs as stenotic (ST) and non-stenotic (NST), based on an absolute cross-sectional area threshold in 276 MS patients and 60 HC, 46 HC lacked this imaging. Individual and total vessel flows were quantified using PC MRI on all subjects. Veins were classified by extracranial drainage type: IJV (I), paraspinal (II), and superficial (III). Differences among HC, MS, non-ST (NST), and ST subgroups in total venous flow by vessel type were evaluated in a general linear model for statistical analysis. Results In the MS group, 153 (55%) evidenced ST, while 12 (20%) HC classified as ST (p<0.001). Compared to HC, the MS group showed lower Type I flow, and increased Type II flow. Stenosis was associated with reduced flow in the Type I vessels: F(1,272)=68, p<0.001. The ST-MS group had increased flow in the Type II vessels compared to NST-MS; F(1,272)=67, p<0.001. Conclusion Compared to HC, MS patients exhibit reduced venous flow in the main extracerebral drainage vein (IJV). In contrast, flow in the paraspinal venous collaterals is elevated in MS patients and exacerbated by venous stenosis. Collateral drainage may be a compensatory response to IJV flow reduction.

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Section: Introductionmentioning

confidence: 99%

Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow

Sethi

Daugherty

Gadda

et al. 2017

AJNR Am J Neuroradiol

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“…When imaging with the current diagnostic methods multiple stenotic patterns or flow abnormalities in the major extracranial and extraspinal veins, which are typical of chronic cerebrospinal venous insufficiency (CCSVI), it is difficult to confidently assign their hemodynamic significance for the intracranial circulation. It has been recently emphasized that the main issue to be investigated in this field is the definition of the hemodynamic impact in the intracranial venous system of obstruction/narrowing of the extracranial veins (46). Since, at this time, there is no established invasive or noninvasive diagnostic imaging modality capable to assess intracranial and/or parenchymal circulatory parameters in relation to extracranial brain outflow (47), the clinical application of the present model seems highly desirable.…”

Section: H224 Hemodynamic Model Of the Cerebral Venous Outflowmentioning

confidence: 99%

A new hemodynamic model for the study of cerebral venous outflow

Gadda

Taibi

Sisini

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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We developed a mathematical model of the cerebral venous outflow for the simulation of the average blood flows and pressures in the main drainage vessels of the brain. The main features of the model are that it includes a validated model for the simulation of the intracranial circulation and it accounts for the dependence of the hydraulic properties of the jugular veins with respect to the gravity field, which makes it an useful tool for the study of the correlations between extracranial blood redistributions and changes in the intracranial environment. The model is able to simulate the average pressures and flows in different points of the jugular ducts, taking into account the amount of blood coming from the anastomotic connections; simulate how the blood redistribution due to change of posture affects flows and pressures in specific points of the system; and simulate redistributions due to stenotic patterns. Sensitivity analysis to check the robustness of the model was performed. The model reproduces average physiologic behavior of the jugular, vertebral, and cerebral ducts in terms of pressures and flows. In fact, jugular flow drops from ϳ11.7 to ϳ1.4 ml/s in the passage from supine to standing. At the same time, vertebral flow increases from 0.8 to 3.4 ml/s, while cerebral blood flow, venous sinuses pressure, and intracranial pressure are constant around the average value of 12.5 ml/s, 6 mmHg, and 10 mmHg, respectively. All these values are in agreement with literature data. mathematical modeling; cerebral outflow; posture dependence; jugular veins collapse; collateral routes THE EXTRACRANIAL VENOUS SYSTEM represents an important determinant of the brain circulation, but its role in the pathology of the central nervous system is not fully understood yet (4,26). It is recognized that, in supine position, the jugular veins represent the main outflow route for the cerebral circulation (2,6,25,36,38), being able to carry most of blood flow from the brain and from other extracerebral territories (ϳ700 -720 ml/ min; Refs. 27, 33) with respect to a cerebral blood inflow of ϳ750 ml/min (45). However, the jugular venous system exhibits important flow limitation during upright posture changes, because the jugular veins tend to collapse as a consequence of the decrease of transmural pressure due to the gravitational field, causing a significant increase in resistance (3,7,12,14,26). In the absence of other routes for extracranial outflow, this flow limitation would have dramatic effects on the cerebral circulation, since, apart from brief transient time intervals, the average cranial arterial inflow is expected to be equal to the cranial venous outflow for the mass preservation.As a consequence, large attention has been devoted to the venous circulation in the upright state, in an effort to understand which alternative routes can carry the brain venous outflow. It has long been postulated that the vertebral venous system may provide an important alternative route for venous outflow when standing or sitting; this was f...

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“…Regarding the extracranial venous system, Zivadinov et al [32] systematically reviewed the extracranial venous system abnormalities and CNS diseases, in which extracranial venous abnormalities were separated into structural/morphological abnormalities, haemodynamic/functional abnormalities, and those determined only by the composite criteria and use of multimodal imaging. The pathophysiology of extracranial venous abnormalities, including decreased cerebral perfusion, cerebral microvascular damage due to increased cerebral venous hypertension, and altered cerebrospinal fluid dynamics, were associated with CNS disease and aging [44]. The internal jugular vein is the most important extracranial venous outflow pathway for the cerebral venous system to collect the venous flow [45].…”

Section: Internal Jugular Vein and Jugular Venous Refluxmentioning

confidence: 99%

Potential Mechanism of Venous System for Leukoaraiosis: From post-mortem to in vivo Research

et al. 2019

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Background: Leukoaraiosis (LA), widely accepted as a feature of cerebral small vessel disease, significantly increases the incidence of stroke, dementia, and death. Cerebral small artery disease has been considered as one of the main causes of LA. However, since the term "venous collagenosis" (VC) was proposed in an atrophy research in 1995, there have been pathological and neuroimaging studies proving the association between the venous system and LA in aging, Alzheimer's disease (AD), and Parkinson's disease. Summary: Autopsy studies confirmed that thickening of the lumen wall in venules, which results from the deposition of collagen I and III, leading to vessel stenosis or occlusion, is closely associated with LA. Susceptibility-weighted imaging research revealed a controversial association of deep medullary veins and LA in vivo, regarding which there are no standard criteria currently. Nevertheless, retinal venous changes had been reported to increase the risk of LA development, providing a novel way for in vivo evaluation. As for the internal jugular vein, jugular venous reflux could double the LA score in aging and modulate circulation of cerebral spinal fluids. Key Messages: Disruption of the venous system was notably associated with LA in aging, AD, and Parkinson's disease postmortem and in in vivo models. The venous pathological changes may induce cerebral hypoperfusion, drainage system disruption, and vasogenic oedema in the veins around the periventricular white matter. The clarification of VC in LA may provide an early prevention and early treatment strategy for LA patients.

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Potential involvement of the extracranial venous system in central nervous system disorders and aging

Cited by 71 publications

References 185 publications

Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow

Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow

A new hemodynamic model for the study of cerebral venous outflow

Potential Mechanism of Venous System for Leukoaraiosis: From post-mortem to in vivo Research

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