Retinal Vessels in Patients with Multiple Sclerosis: Baseline Diameter and Response to Flicker Light Stimulation

Gugleta, Konstantin; Kochkorov, Asan; Kavroulaki, Dimitra; Katamay, Robert; Weier, Katrin; Mehling, Matthias; Kappos, L; Orgül, Selim

doi:10.1055/s-0028-1109289

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…However, if it turns out to be a risk factor for MS, prophylactic and preventive vascular treatment may be helpful. Such an individualized treatment could be based on the outcome of a vascular evaluation such as a dynamic retinal vessel analysis [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Multiple sclerosis and primary vascular dysregulation (Flammer syndrome)

et al. 2016

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BackgroundMultiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS of still unknown aetiology. Flammer syndrome (FS) encompasses a set of symptoms and signs that are primarily but not solely related to the dysregulation of blood vessels. The purpose of the present study was to determine whether FS symptoms occur more often in MS patients than in controls.MethodsFifty-eight MS patients and 259 controls answered a questionnaire covering 15 symptoms and signs of FS.ResultsSix of the 15 symptoms and signs of FS (dizziness, low body mass index, cold hands and/or feet, tendency toward perfectionism, reduced thirst, feeling cold) were found significantly more often in MS patients than in controls. Seven additional symptoms and signs (tinnitus, headaches, increased pain sensation, long sleep-onset time, migraines, increased response to certain drugs, low blood pressure) also occurred more often in MS patients, but the difference in frequency was not statistically significant. One sign (reversible skin blotches) was found less often in MS patients, but the difference in frequency was not statistically significant. One symptom (increased smell perception) was found significantly less often in MS patients.ConclusionsMS patients suffer significantly more often from FS symptoms and signs than controls. The reason for this association between MS and FS and the potential implications of this association still need to be determined.

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Section: Discussionmentioning

confidence: 99%

Multiple sclerosis and primary vascular dysregulation (Flammer syndrome)

et al. 2016

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“…Here, reductions in blood flow volume and velocity have been observed in both retinal arteries and veins [129;130]. Most interestingly, even patients with no history of optic neuritis exhibit retinal arteries that are significantly thinner than normal, as well as significantly thicker venules [131] (see also [44]). Such arterial thinning, perhaps due to constriction, coupled with venular widening, is consistent with many of the vascular observations of MS. Perivenous sheathing has also been observed in optic neuritis [132], in a cohort where more than half the patients subsequently developed MS.…”

Section: Haemodynamic Consequences Of Msmentioning

confidence: 96%

Understanding a role for hypoxia in lesion formation and location in the deep and periventricular white matter in small vessel disease and multiple sclerosis

Sosa

Smith

2017

Clinical Science

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The deep and periventricular white matter is preferentially affected in several neurological disorders, including cerebral small vessel disease (SVD) and multiple sclerosis (MS), suggesting that common pathogenic mechanisms may be involved in this injury. Here we consider the potential pathogenic role of tissue hypoxia in lesion development, arising partly from the vascular anatomy of the affected white matter. Specifically, these regions are supplied by a sparse vasculature fed by long, narrow end arteries/arterioles that are vulnerable to oxygen desaturation if perfusion is reduced (as in SVD, MS and diabetes) or if the surrounding tissue is hypoxic (as in MS, at least). The oxygen crisis is exacerbated by a local preponderance of veins, as these can become highly desaturated 'sinks' for oxygen that deplete it from surrounding tissues. Additional haemodynamic deficiencies, including sluggish flow and impaired vasomotor reactivity and vessel compliance, further exacerbate oxygen insufficiency. The cells most vulnerable to hypoxic damage, including oligodendrocytes, die first, resulting in demyelination. Indeed, in preclinical models, demyelination is prevented if adequate oxygenation is maintained by raising inspired oxygen concentrations. In agreement with this interpretation, there is a predilection of lesions for the anterior and occipital horns of the lateral ventricles, namely regions located at arterial watersheds, or border zones, known to be especially susceptible to hypoperfusion and hypoxia. Finally, mitochondrial dysfunction due to genetic causes, as occurs in leucodystrophies or due to free radical damage, as occurs in MS, will compound any energy insufficiency resulting from hypoxia. Viewing lesion formation from the standpoint of tissue oxygenation not only reveals that lesion distribution is partly predictable, but may also inform new therapeutic strategies.

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“…In some MS patients, ET-1 in the circulating blood [62] is increased, and therefore, ocular blood flow (OBF) decreased (Figure 5). This might contribute to the loss of retinal ganglion cells and their axons [63], to subclinical visual field defects [64], to narrower retinal arterioles and wider venules [65] and to increased rigidity of the retinal vessels [66]; furthermore, it may partially be the reason the ONH can turn slightly pale. Red wine can reduce ET-1 concentration which therefore explains why certain symptoms like visual disturbances in MS patients are reduced by red wine for a limited period of time [67].…”

Section: Vascular Dysregulationmentioning

confidence: 99%

The primary vascular dysregulation syndrome: implications for eye diseases

2013

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Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood–brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.

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Retinal Vessels in Patients with Multiple Sclerosis: Baseline Diameter and Response to Flicker Light Stimulation

Abstract: Narrower arterioles and wider venules might be a consequence of subclinical swelling of optic nerve axons in eyes with negative history of ON in MS patients.

Cited by 7 publications

References 19 publications

Multiple sclerosis and primary vascular dysregulation (Flammer syndrome)

Multiple sclerosis and primary vascular dysregulation (Flammer syndrome)

Understanding a role for hypoxia in lesion formation and location in the deep and periventricular white matter in small vessel disease and multiple sclerosis

The primary vascular dysregulation syndrome: implications for eye diseases

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