This Is MS Multiple Sclerosis Community: Knowledge & Support

Abstract

INTRODUCTION: Recently, a chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI) was claimed to be a pathologic condition exclusively seen in patients with multiple sclerosis (MS), suggesting that cerebral venous congestion plays a significant role in the pathogenesis of MS. This hypothesis has gained enormous attention among patients and physicians but has been questioned since.

METHODS: Twenty seven patients with MS and 32 healthy controls underwent color extra cranial Doppler exam aimed to detect four parameters of abnormal venous flow: no Doppler-detected flow in the IJV or vertebral veins (VV), reflux in the internal jugular veins (IJVs), venous flow stenosis in the IJVz (cross sectional area <0.3cm) or reverted postural control in the IJV.

RESULTS: Except for one healthy patient, blood flow direction in the IJVs was normal in all subjects. When aiming to detect at least one parameter of abnormal venous flow per subject, two parameters or three parameters no significant difference was found between subjects and controls (p=0.707, 0.62, 0.849 respectively).

CONCLUSION: We found no evidence to suggest that MS patients have excess of CCSVI. In addition we failed to observe a typical venous flow pattern in MS patients. Until carefully designed controlled studies to investigate CCVSI have been completed, invasive and potentially dangerous endovascular procedures as therapy for MS should be discouraged.

Twenty seven patients with MS and 32 healthy controls underwent color extra cranial Doppler exam aimed to detect four parameters of abnormal venous flow: no Doppler-detected flow in the IJV or vertebral veins (VV), reflux in the internal jugular veins (IJVs), venous flow stenosis in the IJVz (cross sectional area <0.3cm) or reverted postural control in the IJV.

By this definition, my right jugular which was 80% stenosed would not have counted as stenosed.

(The CSA of my valve opening was 33 mm which is 3 mm larger than .3 cm. The CSA of the vein itself was 149 mm thus the 80% stenosis.)

J Neurol Sci. 2011

Aug 3. [Epub ahead of print]

Extra-cranial venous flow in patients with multiple sclerosis.

Auriel E, Karni A, Bornstein NM, Nissel T, Gadoth A, Hallevi H.SourceStroke Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.



http://www.ncbi.nlm.nih.gov/pubmed/21820131

why are CSA measurements not in units squared?

There is an urgent need to define and validate the spectrum of cranial/extracranial venous anomalies and to establish reliable, diagnostic gold-standard test(s).

The mean size of the IJV was 1.42 ± 0.344 cm (range 0.5–2.2) on the right side and 1.22 ± 0.379 cm (range 0.33–2.4) on the left side. Overall, the right IJV was significantly larger than the left IJV (P < .001). There was no difference in the size of the veins between the two study groups. The mean IJV size on the right was 1.48 cm in men and 1.27 cm in women; the corresponding figures for the left side were 1.37 cm and 1.17 cm. The vein was significantly larger in men than in women on both sides (P < .05).

... invasive and potentially dangerous endovascular procedures as therapy for MS should be discouraged.