Extracranial Doppler sonographic criteria of chronic cerebrospinal venous insufficiency in the patients with multiple sclerosis

• Published in: International angiology Vol. 29; no. 2; pp. 109 - 114
• Main Authors: SIMKA, M, KOSTECKI, J, ZANIEWSKI, M, MAJEWSKI, E, HARTEL, M
• Format: Journal Article
• Language: English
• Published: Torino Minerva Medica 01.04.2010; Edizioni Minerva Medica
• Subjects: Adolescent; Adult; Biological and medical sciences; Blood and lymphatic vessels; Brachiocephalic Veins - abnormalities; Brachiocephalic Veins - diagnostic imaging; Brachiocephalic Veins - physiopathology; Cardiology. Vascular system; Cardiovascular system; Chi-Square Distribution; Chronic Disease; Constriction, Pathologic; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Jugular Veins - abnormalities; Jugular Veins - diagnostic imaging; Jugular Veins - physiopathology; Male; Medical sciences; Middle Aged; Multiple Sclerosis, Chronic Progressive - diagnostic imaging; Multiple Sclerosis, Chronic Progressive - physiopathology; Multiple Sclerosis, Relapsing-Remitting - diagnostic imaging; Multiple Sclerosis, Relapsing-Remitting - physiopathology; Regional Blood Flow; Spinal Cord - blood supply; Syndrome; Ultrasonic investigative techniques; Ultrasonography, Doppler, Color; Venous Insufficiency - diagnostic imaging; Venous Insufficiency - physiopathology; Young Adult; Sonography; Doppler ultrasound study; Human; Nervous system diseases; Multiple sclerosis; Color; Venous insufficiency; Cardiovascular disease; Extracranial; Venous incompetence; Inflammatory disease; Venous disease; Vascular disease; Chronic; Central nervous system disease; Varix; Color Ultrasonography, Doppler, color
• ISSN: 0392-9590; 1827-1839

The aim of this open-label study was to assess extracranial Doppler criteria of chronic cerebrospinal venous insufficiency in multiple sclerosis patients. Seventy patients were assessed: 49 with relapsing-remitting, 5 with primary progressive and 16 with secondary progressive multiple sclerosis. The patients were aged 15-58 years and they suffered from multiple sclerosis for 0.5-40 years. Sonographic signs of abnormal venous outflow were detected in 64 patients (91.4%). We found at least two of four extracranial criteria in 63 patients (90.0%), confirming that multiple sclerosis is stronghly associated with chronic cerebrospinal venous insufficiency. Additional transcranial investigations may increase the rate of patients found positive in our survey. Reflux in internal jugular and/or vertebral veins was present in 31 cases (42.8%), stenosis of internal jugular veins in 61 cases (87.1%), not detectable flow in internal jugular and/or vertebral veins in 37 cases (52.9%) and negative difference in cross-sectional area of the internal jugular vein assessed in the supine vs. sitting position in 28 cases (40.0%). Flow abnormalities in the vertebral veins were found in 8 patients (11.4%). Pathologic structures (membranaceous or netlike septa, or inverted valves) in the junction of internal jugular vein with brachiocephalic vein were found in 41 patients (58.6%), in 15 patients (21.4%) on one side only and in 26 patients (37.1%) bilaterally. Multiple sclerosis is highly correlated with chronic cerebrospinal venous insufficiency. These abnormalities in the extracranial veins draining the central nervous system can exist in various combinations. The most common pathology in our patients was the presence of an inverted valve or another pathologic structure (like membranaceous or netlike septum) in the area of junction of the IJV with the brachiocephalic vein.