Venography findings in patients with MS undergoing an evaluation for CCSVI: correlation with MS subtype and the patients presenting symptom.
Abstract of the year:
A. Bagherpour1, 2, M. Englander1, K. Mandato1, G. Siskin1, L. Thanjan1, 3
1. Albany Medical Center, Albany, NY, United States. 2. Radiology, The Unviersity of Texas Health Science Center, San Antonio , TX, United States. 3. The George Washington University, Washington D.C., DC, United States.
Arvin Bagherpour, MD - View Disclosure
University of Texas Health Science Center
San Antonio, TX
To compare the findings on venography with presenting clinical symptoms of multiple sclerosis (MS) in patients undergoing an evaluation for chronic cerebrospinal venous insufficiency (CCSVI).
A retrospective study of MS patients being evaluated for CCSVI during a 6 month period was performed. Findings on venography were classified based on the distribution of stenosis within the internal jugular and azygos veins and compared with the presenting clinical symptoms of MS.
318 patients were treated during the study period; the study population consisted of 239 patients (mean 50.2 years; 37% male and 63% female). Patients without complete historical data available for analysis were excluded from analysis. The distribution of symptoms were as follows: 23/239 (9.6%) presented with fatigue, 43/239 (18%) presented with balance problems, 99/239 (41.4%) presented with numbness/tingling, 63/239 (26.4%) presented with weakness, 70/239 (29.3%) presented with visual type symptoms, and 8/239 (3.3%) presented with bladder/bowel dysfunction. Based on the previously described classification system for venography findings, 37/239 (15.5%) patients had a Type A pattern, 93/239(38.9%) patients had a Type B pattern,104/239 (43.5%) patients had a Type C pattern, and 5/239 (2.1%) patients had a Type D pattern. The findings on venography were not associated with the presence of fatigue (p=0.4268), the presence of numbness/tingling (p=0.2088), the presence of weakness (p=0.8802), the presence of visual problems (p=0.7602) or the the presence of bladder/bowel dysfunction (p=0.0615). However, an association was found in the presence of balance disturbances (p=0.0235).
The presence of bladder dysfunction, fatigue, numbness/tingling, weakness, visual symptoms at the time of diagnosis are not predictive of the findings seen on catheter venography performed as part of an evaluation for CCSVI. However, an association was found in the presence of balance disturbances. A prospective trial is needed to further evaluate findings on venography and treatment outcomes.
Back in 2008 or so, Dr. Zamboni published a paper which looked at the different types of CCSVI that can present themselves: one jugular stenosed, two jugulars stenosed, one jugular and an azygous stenosed, all three veins stenosed, that sort of thing. They were labelled Type A, Type B, Type C or Type D. He observed that some types of CCSVI appeared to be associated with the different subtypes of MS (RR, SP, PP). With the later discovery that left renal vein compression can also be a factor in CCSVI, I would think that would need to be included in the patterns, so I am not convinced that it is a perfect classification system.
Dr. Siskin looked to see if any particular presenting symptom of MS was associated with any of these patterns. I would have hypothesized, for example, that bilateral jugular obstruction might be associated with greater fatigue than unilateral jugular obstruction. But no, there was no association found with any of the symptoms except for one, which was balance disturbances. The abstract does not tell us which ccsvi pattern is associated with balance disturbances, only that there is an association.
This mostly supports the idea that it is the overall slowdown in extracranial drainage that impacts us and that it doesn't matter particularly whether it is a unilateral or bilateral jugular stenosis or a combination of azygous and jugular stenoses.
I wouldn't mind seeing research looking specifically at the CSA area measurements of each vein. A 50% stenosed left jugular that is a 14 mm vein is more or less the same as a 0% stenosed left jugular that is 7 mm. Maybe we can classify based on CSA measurements.