The aim of our study was to analyze morphological and functional aspects of cerebral veins by mean of eco-color-Doppler in young (i.e., ≤30 years old) and older (i.e., >30 years old) patients suffering from multiple sclerosis. 552 multiple sclerosis patients were evaluated by mean of a dedicated Echo-Color-Doppler support (MyLab Vinco echo-color Doppler System, Esaote), in both supine and sitting positions. 458 (83%) showed alterations in their morphological and functional structures of cerebral veins and were divided in two different groups: 1) ≤30 (110 patients) and 2) >30 years old (348 patients).
Young patients showed a statistically significant higher number of both hemodinamically (44% vs 35%, p<0.01) and non-hemodinamically (51% vs 45%, p<0.05) significant stenosis in the internal jugular veins.
A lower percentage of young patients showed blocked outflow in the cervical veins (50% vs 65%, p<0.01) as compared to older. Patients >30 years old outlined a significant higher disability degree (Expanded Disability Status Scale score: 5 vs 3, p<0.01) as well as higher disease duration (12 vs 5 months, p<0.01) than younger. No differences could be outlined about multiple sclerosis clinical form of the disease.
Young and adult groups are different kind of patients, the former showing much more cerebral veins stenosis and blocked flow in internal jugular veins and vertebral veins than the latter. Duration of disease could explain such differences: the higher the diseases duration, the higher the degree of vascular alterations and, therefore, the disability degree.
This could be due to the complex venous hemodynamic impairments induced by the alterations in vascular walls: the blocked or difficult blood flow through stenosis could increase the hydrostatic pressure in the skull and this could induce cerebral cells damages that could lead to the genesis of more advanced morphological abnormalities.
Furthermore, the vessels' alterations could impair venous endothelial functions which could turn in a possible alteration of the controls of cerebral vein return which could worsen the cerebral vascular outflow. It may be possible that early clinical, pharmacological and/or invasive vascular interventions could exert a possible role in the natural history of multiple sclerosis course. Nevertheless, further trials are needed in order to confirm such considerations.
Please fight against the MS section of the new ICD 11 at http://apps.who.int/classifications/icd11/browse/f/en