Multiple sclerosis: clinical aspectsMonday, June 21, 2010, 11:30 - 13:00
Chronic cerebro-spinal venous insuficiency in multiple sclerosis – Old theory, new question marks?O. Dolezal, A. Lopez Soriano, E. Havrdova (Prague, CZ; Barcelona, ES)
Objectives: According to recent publications where the role of chronic cerebro spinal venous insuficiency (CCSVI) in MS ethiology was mentioned, we tried in our study to evaluate the quality of venous drainage in normal controls. We also followed one subject for the 3 day period , studying intrapersonal time variation of venous drainage. Acording to this evaluation we tried to formulate our opinion about possible intravascular intervention.
Methods: We examined 10 non MS subjects. Mean age of subjects was 30.3 yrs. The patients were negative according to chronic venous insuficiency in lower extremities. We were respecting criteria proposed by Zamboni 2009, we did not include transcranial examination. In the second phase we followed one subject (normal control) for the period of 3 consecutive days. We used Toshiba Nemio ultrasound machine. For evaluation of CCSVI we used venous hemodynamic severity score (VHSS) proposed by Zamboni et. al 2009.
Results: Four normal controls from our group had at least one point in venous hemodynamics severity score (VHSS) and one subject fullfill two criteria of CCSVI (negative cross-sectional area of jugular vein in supine position and non detectable flow in one major vein). Subject followed for three consecutive days showed day to day variation especially in jugular and vertebral diameter in supine and in upright position as well (range 4x3 mm to 10 x 4 mm in left jugular and 3.5 x 1.4mm to 6.8 x 2.3 mm in right jugular vein in upright, and 1.8 mm to 3.8 mm of anterior- posterior diameter in upright position of vertebral vein on the left side)
Conclusions: In our group we found one false positive patient according to CCSVI criteria and four borderline cases. We found significant day to day variation of ultrasound findings in major neck veins in our one case study. Regarding to extremely small amount of patients we can not make relevant conclusions but presence of signs of CCSVI in normal subjects and variation of venous drainage intrapersonally is interesting. It opens new serious questions about ethiological link of CCSVI and MS and indication of intravascular intervention, because percutaneous transluminal angioplasty (PTA) does not seem to be optimal procedure in potential venous insuficiency.