Hemodynamic patterns of chronic cerebrospinal venous insufficiency in multiple sclerosis. Correlation with symptoms at onset and clinical course.
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.
Bartolomei
I
I
Center for Rare and Neuroimmunitary Diseases, Department of Neurological Science, Bellaria Hospital, Bologna, Italy.
Salvi
F
F
Galeotti
R
R
Salviato
E
E
Alcanterini
M
M
Menegatti
E
E
Mascalchi
M
M
Zamboni
P
P
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*