Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis: The
Hydrostatic-Immune Paradigm and the Flow Cytometry as a Diagnostic Tool
In recent years, chronic cerebro-spinal venous insufficiency (CCSVI) has been associated with multiple sclerosis
(MS). Balloon angioplasty of the affected veins (internal jugulars, azygos) has been proposed as a treatment
method, with controversial results. The conflict is based on how a primarily immune disease can be affected by a
primarily hydrostatic condition and its reversal. In our paper we briefly review novel paradigms in multiple sclerosis
pathogenesis and propose a mechanism by which CCSVI could theoretically lead to blood brain barrier disruption,
altered neuronal microenvironment, astrocyte and oligodendrocyte loss and demyelination. Altered antigen transfer
to regional lymph nodes, affecting antigen presentation and processing could also contribute, affecting the sensitive
balance between tolerance and immunity. Thus, a combined hydrostatic-immune paradigm of MS emerges, which
may explain the potential role of CCSVI in MS pathogenesis and provide a theoretical framework for future research.
Has this been posted? It was published April 26th.