title: Evidence against the involvement of chronic cerebrospinal venous abnormalities in multiple sclerosis. A case-control study.
abstract: OBJECTIVE
  Multiple sclerosis (MS) is a chronic neurodegenerative disease of the CNS. Recently a controversial vascular hypothesis for MS, termed chronic cerebrospinal venous insufficiency (CCSVI), has been advanced. The objective of this study was to evaluate the relative prevalence of the venous abnormalities that define CCSVI.
  
  
  METHODS
  A case-control study was conducted in which 100 MS patients aged between 18-65 y meeting the revised McDonald criteria were randomly selected and stratified into one of four MS subtypes: relapsing/remitting, secondary progressive, primary progressive and benign. Control subjects (16-70 y) with no known history of MS or other neurological condition were matched with the MS cases. All cases and controls underwent ultrasound imaging of the veins of the neck plus the deep cerebral veins, and magnetic resonance imaging of the neck veins and brain. These procedures were performed on each participant on the same day.
  
  
  RESULTS
  On ultrasound we found no evidence of reflux, stenosis or blockage in the internal jugular veins (IJV) or vertebral veins (VV) in any study participant. Similarly, there was no evidence of either reflux or cessation of flow in the deep cerebral veins in any subject. Flow was detected in the IJV and VV in all study participants. Amongst 199 participants there was one MS subject who fulfilled the minimum two ultrasound criteria for CCSVI. Using MRI we found no significant differences in either the intra- or extra-cranial venous flow velocity or venous architecture between cases and controls.
  
  
  CONCLUSIONS
  This case-control study provides compelling evidence against the involvement of CCSVI in multiple sclerosis.
authors: Department of Medicine, McMaster University, Hamilton, Ontario, Canada. rodgeri@mcmaster.ca
authors: Ian W
authors: IW
authors: Rodger
authors: Dorothy
authors: D
authors: Dilar
authors: Janet
authors: J
authors: Dwyer
authors: John
authors: J
authors: Bienenstock
authors: Andu
authors: A
authors: Coret
authors: Judith
authors: J
authors: Coret-Simon
authors: Gary
authors: G
authors: Foster
authors: Arlene
authors: A
authors: Franchetto
authors: Slobodan
authors: S
authors: Franic
authors: Charles H
authors: CH
authors: Goldsmith
authors: David
authors: D
authors: Koff
authors: Norman B
authors: NB
authors: Konyer
authors: Mitchell
authors: M
authors: Levine
authors: Ellen
authors: E
authors: McDonald
authors: Michael D
authors: MD
authors: Noseworthy
authors: John
authors: J
authors: Paulseth
authors: Luciana
authors: L
authors: Ribeiro
authors: Mary Jane
authors: MJ
authors: Sayles
authors: Lehana
authors: L
authors: Thabane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply*; D016022:Case-Control Studies; D003251:Constriction, Pathologic / Q000150:complications; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013116:Spinal Cord / Q000098:blood supply*; D016683:Supine Position; D018608:Ultrasonography, Doppler; D014689:Venous Insufficiency; D055815:Young Adult
references: Ann Neurol. 2010 Aug;68(2):255-9
references: 20695018
references: J Neurol. 2012 Dec;259(12):2585-9
references: 22648477
references: Mult Scler. 2013 May;19(6):749-56
references: 22961213
references: Ann Neurol. 2005 Dec;58(6):840-6
references: 16283615
references: Radiology. 2001 Jul;220(1):244-51
references: 11426005
references: J Magn Reson Imaging. 2012 May;35(5):1055-62
references: 22170792
references: Neurol Sci. 2013 Mar;34(3):269-79
references: 22569567
references: J Cereb Blood Flow Metab. 2009 Dec;29(12):1867-78
references: 19724286
references: N Engl J Med. 2006 Aug 3;355(5):488-98
references: 16885552
references: J Neurol Neurosurg Psychiatry. 2011 Apr;82(4):436-40
references: 21296899
references: PLoS One. 2013;8(2):e56031
references: 23418501
references: J Neurol Neurosurg Psychiatry. 2011 Apr;82(4):429-35
references: 20980483
references: Med Hypotheses. 1986 Oct;21(2):141-8
references: 3641027
references: Mult Scler. 2010 Nov;16(11):1341-8
references: 21041329
references: Funct Neurol. 2009 Jul-Sep;24(3):133-8
references: 20018140
references: N Engl J Med. 2006 Mar 2;354(9):942-55
references: 16510748
references: Ann Neurol. 2010 Aug;68(2):173-83
references: 20695010
references: Neurology. 1983 Nov;33(11):1444-52
references: 6685237
references: Ann Neurol. 2001 Jul;50(1):121-7
references: 11456302
references: J Neurol Neurosurg Psychiatry. 2009 Apr;80(4):392-9
references: 19060024
references: J Neurol Sci. 2009 Jul 15;282(1-2):21-7
references: 19144359
references: BMC Neurol. 2013 Feb 13;13:20
references: 23406210
references: Clin Neurol Neurosurg. 2013 Aug;115(8):1394-8
references: 23384545
references: J Cereb Blood Flow Metab. 2013 May;33(5):657-68
references: 23443168
references: J Vasc Surg. 2009 Dec;50(6):1348-58.e1-3
references: 19958985
references: CMAJ. 2011 Nov 8;183(16):1824-5
references: 21969409
references: Neurology. 2011 Nov 8;77(19):1745-51
references: 22031530
references: Phlebology. 2012 Mar;27 Suppl 1:107-13
references: 22312076
references: N Engl J Med. 2000 Sep 28;343(13):938-52
references: 11006371
references: Ann Neurol. 2013 Jun;73(6):721-8
references: 23418024
references: Neurology. 2011 Aug 30;77(9):844-50
references: 21849656
references: Acta Neurol Scand. 2012 Dec;126(6):421-7
references: 22530753
references: CMAJ. 2011 Nov 8;183(16):E1203-12
references: 21969411
references: Neurology. 2011 Jul 12;77(2):138-44
references: 21490322