Diagnosis & differential diagnosis 2Friday, October 15, 2010, 15:30 - 17:00
No evidence for cerebro-cervical venous congestion in patients with multiple sclerosisF. Doepp, F. Paul, J.M. Valdueza, K. Schmierer, S.J. Schreiber (Berlin, Bad Segeberg, DE; London, GB)
Background: Multiple sclerosis (MS) is characterized by demyelination centered around cerebral veins. Recent studies suggested this topographic pattern may be caused by cerebral venous congestion, a condition termed 'chronic cerebro-spinal venous insufficiency' ('CCSVI'). In a recently published study we were unable to reproduce the reported findings of reflux in the deep cerebral veins and/or the internal jugular and vertebral veins (IJVs and VVs), stenosis of the IJVs, missing flow in IJVs and VVs, and inverse postural response of the cerebral venous drainage (Ann Neurol, in press).
Methods: We performed extra- and transcranial Doppler ultrasound studies including analysis of extracranial venous blood volume flow (BVF), cross-sectional areas, IJV flow analysis during valsalva manoever (VM) and 'CCSVI' criteria in 59 patients with MS (target: 80 patients) and 20 reference subjects.
Results: Except for one patient, blood flow direction in the IJVs and VVs was normal in all subjects. In none of the subjects was IJV stenosis detected. IJV and VV BVF in both groups were equal in the supine body position. The decrease of total jugular BVF upon turning into the upright position was less pronounced in patients (173 ± 235 vs 362 ± 150 ml/min; p<0.001), leading to higher BVF in the latter position (318 ml/min ± 242 vs 123 ± 109 ml/min; p<0.001). No difference between patients and controls was detected in intracranial veins and during VM. None of the subjects investigated in this study fulfilled more than one criterion for 'CCSVI'.
Conclusion: This data confirms in a larger cohort our recently published study challenging the hypothesis that cerebral venous congestion plays a significant role in the pathogenesis of MS. Future studies should elucidate the difference between patients and healthy subjects in BVF regulation.
KS is supported by a Higher Education Funding Council for England (HEFCE) Clinical Senior Lectureship. KS has received speaker honoraria from Sanofi-Aventis, Novartis and Merck-Serono.