title: Clinical correlates of chronic cerebrospinal venous insufficiency in multiple sclerosis.
abstract: BACKGROUND
  Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of the primary veins outside the skull that has been reported to be associated with MS. In the blinded Combined Transcranial (TCD) and Extracranial Venous Doppler Evaluation (CTEVD) study, we found that prevalence of CCSVI was significantly higher in multiple sclerosis (MS) vs. healthy controls (HC) (56.1% vs. 22.7%, p < 0.001).The objective was to evaluate the clinical correlates of venous anomalies indicative of CCSVI in patients with MS.
  
  
  METHODS
  The original study enrolled 499 subjects; 163 HC, 289 MS, 21 CIS and 26 subjects with other neurological disorders who underwent a clinical examination and a combined Doppler and TCD scan of the head and neck. This analysis was restricted to adult subjects with MS (RR-MS: n = 181, SP-MS: n = 80 and PP-MS: n = 12). Disability status was evaluated by using the Kurtzke Expanded Disability Status Scale (EDSS) and MS severity scale (MSSS).
  
  
  RESULTS
  Disability was not associated with the presence (≥2 venous hemodynamic criteria) or the severity of CCSVI, as measured with venous hemodynamic insufficiency severity score (VHISS). However, the severity of CCSVI was associated with the increased brainstem functional EDSS sub-score (p = 0.002). In logistic regression analysis, progressive MS (SP-MS or PP-MS) vs. non-progressive status (including RR-MS) was associated with CCSVI diagnosis (p = 0.004, OR = 2.34, CI = 1.3-4.2).
  
  
  CONCLUSIONS
  The presence and severity of CCVSI in multiple sclerosis correlate with disease status but has no or very limited association with clinical disability.
authors.affiliation: Department of Neurology, State University of New York, Buffalo, NY, USA. BWeinstock-Guttman@Kaleidahealth.org
authors.forename: Bianca
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.forename: Murali
authors.initials: M
authors.lastname: Ramanathan
authors.forename: Karen
authors.initials: K
authors.lastname: Marr
authors.forename: David
authors.initials: D
authors.lastname: Hojnacki
authors.forename: Ralph H B
authors.initials: RH
authors.lastname: Benedict
authors.forename: Charity
authors.initials: C
authors.lastname: Morgan
authors.forename: Eluen Ann
authors.initials: EA
authors.lastname: Yeh
authors.forename: Ellen
authors.initials: E
authors.lastname: Carl
authors.forename: Cheryl
authors.initials: C
authors.lastname: Kennedy
authors.forename: Justine
authors.initials: J
authors.lastname: Reuther
authors.forename: Christina
authors.initials: C
authors.lastname: Brooks
authors.forename: Kristin
authors.initials: K
authors.lastname: Hunt
authors.forename: Makki
authors.initials: M
authors.lastname: Elfadil
authors.forename: Michelle
authors.initials: M
authors.lastname: Andrews
authors.forename: Robert
authors.initials: R
authors.lastname: Zivadinov
mesh_terms: D002550:Cerebral Veins / Q000000981:diagnostic imaging; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D009518:New York / Q000453:epidemiology; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000706:statistics & numerical data*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology*