title: Hemodynamic patterns of chronic cerebrospinal venous insufficiency in multiple sclerosis. Correlation with symptoms at onset and clinical course.
abstract: OBJECTIVE
  Chronic cerebrospinal venous insufficiency (CCSVI) is associated with multiple sclerosis (MS). CCSVI is detected by transcranial and extracranial color-Doppler high-resolution examination (TCCS-ECD) and venography that permit to identify five types of venous malformations and four major (A-D) hemodynamic patterns of anomalous extracranial-extravertebral venous outflow. We investigated possible correlation between such hemodynamic patterns and both the symptoms at onset and clinical course in patients with MS and CCSVI.
  
  
  METHODS
  TCCS-ECD, selective venography and clinical records of 65 patients affected by definite MS and CCSVI were reviewed.
  
  
  RESULTS
  The four hemodynamic patterns of CCSVI were unevenly (P<0.0001) distributed with respect to the types of clinical presentation and course. In particular the Type A or B patterns were common in patients with onset of optic neuritis, but rare in patients presenting with spinal cord symptoms who typically showed a type D pattern. As well, the type A or type B hemodynamic were more common in patients with relapsing remitting course than in patients with secondary progressive course and rare in patients with primary progressive course. The C hemodynamic pattern was not observed in patients with primary progressive course who showed a remarkable prevalence of the type D pattern.
  
  
  CONCLUSIONS
  The distribution of venous malformations and the resulting hemodynamic pattern show correlation with symptoms at onset and clinical course in patients with MS and CCSVI.
authors.affiliation: Center for Rare and Neuroimmunitary Diseases, Department of Neurological Science, Bellaria Hospital, Bologna, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Bartolomei
authors.forename: F
authors.initials: F
authors.lastname: Salvi
authors.forename: R
authors.initials: R
authors.lastname: Galeotti
authors.forename: E
authors.initials: E
authors.lastname: Salviato
authors.forename: M
authors.initials: M
authors.lastname: Alcanterini
authors.forename: E
authors.initials: E
authors.lastname: Menegatti
authors.forename: M
authors.initials: M
authors.lastname: Mascalchi
authors.forename: P
authors.initials: P
authors.lastname: Zamboni
mesh_terms: D001401:Azygos Vein / Q000002:abnormalities / Q000503:physiopathology*; D002550:Cerebral Veins / Q000503:physiopathology; D002908:Chronic Disease; D003251:Constriction, Pathologic; D018450:Disease Progression; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007601:Jugular Veins / Q000002:abnormalities / Q000503:physiopathology*; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000503:physiopathology*; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis / Q000503:physiopathology; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000503:physiopathology; D009902:Optic Neuritis / Q000175:diagnosis / Q000503:physiopathology; D010690:Phlebography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013116:Spinal Cord / Q000098:blood supply; D018615:Ultrasonography, Doppler, Color; D054079:Vascular Malformations / Q000175:diagnosis / Q000503:physiopathology*; D014689:Venous Insufficiency / Q000175:diagnosis / Q000503:physiopathology*