title: Blood pressure normalization post-jugular venous balloon angioplasty.
abstract: OBJECTIVE
  This study is the first in a series investigating the relationship between autonomic nervous system dysfunction and chronic cerebrospinal venous insufficiency in multiple sclerosis patients. We screened patients for the combined presence of the narrowing of the internal jugular veins and symptoms of autonomic nervous system dysfunction (fatigue, cognitive dysfunction, sleeping disorders, headache, thermal intolerance, bowel/bladder dysfunction) and determined systolic and diastolic blood pressure responses to balloon angioplasty.
  
  
  METHODS
  The criteria for eligibility for balloon angioplasty intervention included ≥ 50% narrowing in one or both internal jugular veins, as determined by the magnetic resonance venography, and ≥ 3 clinical symptoms of autonomic nervous system dysfunction. Blood pressure was measured at baseline and post-balloon angioplasty.
  
  
  RESULTS
  Among patients who were screened, 91% were identified as having internal jugular veins narrowing (with obstructing lesions) combined with the presence of three or more symptoms of autonomic nervous system dysfunction. Balloon angioplasty reduced the average systolic and diastolic blood pressure. However, blood pressure categorization showed a biphasic response to balloon angioplasty. The procedure increased blood pressure in multiple sclerosis patients who presented with baseline blood pressure within lower limits of normal ranges (systolic ≤ 105 mmHg, diastolic ≤ 70 mmHg) but decreased blood pressure in patients with baseline blood pressure above normal ranges (systolic ≥ 130 mmHg, diastolic ≥ 80 mmHg). In addition, gender differences in baseline blood pressure subcategories were observed.
  
  
  CONCLUSIONS
  The coexistence of internal jugular veins narrowing and symptoms of autonomic nervous system dysfunction suggests that the two phenomena may be related. Balloon angioplasty corrects blood pressure deviation in multiple sclerosis patients undergoing internal jugular vein dilation. Further studies should investigate the association between blood pressure deviation and internal jugular veins narrowing, and whether blood pressure normalization affects Patient's clinical outcomes.
authors.affiliation: Synergy Health Concepts, Newport Beach, CA, USA.
authors.forename: Zohara
authors.initials: Z
authors.lastname: Sternberg
authors.affiliation: Dept. of Neurology, Stroke Center, Buffalo Medical Center, Buffalo, NY, USA.
authors.forename: Prabhjot
authors.initials: P
authors.lastname: Grewal
authors.affiliation: Dept. of Neurology, Stroke Center, Buffalo Medical Center, Buffalo, NY, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Cen
authors.affiliation: Dept. of Neurology, Stroke Center, Buffalo Medical Center, Buffalo, NY, USA.
authors.forename: Frances
authors.initials: F
authors.lastname: DeBarge-Igoe
authors.affiliation: Synergy Health Concepts, Newport Beach, CA, USA.
authors.forename: Jinhee
authors.initials: J
authors.lastname: Yu
authors.affiliation: Dept. of Neurology, Stroke Center, Buffalo Medical Center, Buffalo, NY, USA endovasc@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Arata
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D001794:Blood Pressure; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D011311:Pressoreceptors / Q000502:physiology; D012720:Severity of Illness Index; D012737:Sex Factors; D063189:Symptom Assessment; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
keywords: Balloon angioplasty; CCSVI; blood pressure deviation; dysautonomia; gender differences; high pressure baroreceptors