title: Extra-cranial venous flow in patients with multiple sclerosis.
abstract: BACKGROUND
  Recently, a chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI) was claimed to be a pathologic condition exclusively seen in patients with multiple sclerosis (MS), suggesting that cerebral venous congestion plays a significant role in the pathogenesis of MS. This hypothesis has gained enormous attention among patients and physicians but has been questioned since.
  
  
  METHODS
  Twenty seven patients with MS and 32 healthy controls underwent color extra cranial Doppler exam aimed to detect four parameters of abnormal venous flow: no Doppler-detected flow in the IJV or vertebral veins (VV), reflux in the internal jugular veins (IJVs), venous flow stenosis in the IJVz (cross sectional area <0.3 cm) or reverted postural control in the IJV.
  
  
  RESULTS
  Except for one healthy patient, blood flow direction in the IJVs was normal in all subjects. When aiming to detect at least one parameter of abnormal venous flow per subject, two parameters or three parameters no significant difference was found between subjects and controls (p = 0.707, 0.62, 0.849 respectively).
  
  
  CONCLUSIONS
  We found no evidence to suggest that MS patients have excess of CCSVI. In addition we failed to observe a typical venous flow pattern in MS patients. Until carefully designed controlled studies to investigate CCVSI have been completed, invasive and potentially dangerous endovascular procedures as therapy for MS should be discouraged.
authors.affiliation: Stroke Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. eitanman1@gmail.com
authors.forename: E
authors.initials: E
authors.lastname: Auriel
authors.forename: A
authors.initials: A
authors.lastname: Karni
authors.forename: N M
authors.initials: NM
authors.lastname: Bornstein
authors.forename: T
authors.initials: T
authors.lastname: Nissel
authors.forename: A
authors.initials: A
authors.lastname: Gadoth
authors.forename: H
authors.initials: H
authors.lastname: Hallevi
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology