title: Ultrasonographic evaluation of cerebral arterial and venous haemodynamics in multiple sclerosis: a case-control study.
abstract: OBJECTIVE
  Although recent studies excluded an association between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis (MS), controversial results account for some cerebrovascular haemodynamic impairment suggesting a dysfunction of cerebral autoregulation mechanisms. The aim of this cross-sectional, case-control study is to evaluate cerebral arterial inflow and venous outflow by means of a non-invasive ultrasound procedure in Relapsing Remitting (RR), Primary Progressive (PP) Multiple Sclerosis and age and sex-matched controls subjects.
  
  
  METHODS
  All subjects underwent a complete extra-intracranial arterial and venous ultrasound assessment with a color-coded duplex sonography scanner and a transcranial doppler equipment, in both supine and sitting position by means of a tilting chair. Basal arterial and venous morphology and flow velocities, postural changes in mean flow velocities (MFV) of middle cerebral arteries (MCA), differences between cerebral venous outflow (CVF) in clinostatism and in the seated position (ΔCVF) and non-invasive cerebral perfusion pressure (CPP) were evaluated.
  
  
  RESULTS
  85 RR-MS, 83 PP-MS and 82 healthy controls were included. ΔCVF was negative in 45/85 (52.9%) RR-MS, 63/83 (75.9%) PP-MS (p = 0.01) and 11/82 (13.4%) controls (p<0.001), while MFVs on both MCAs in sitting position were significantly reduced in RR-MS and PP-MS patients than in control, particularly in EDSS ≥ 5 subgroup (respectively, 42/50, 84% vs. 66/131, 50.3%, p<0.01 and 48.3 ± 2 cm/s vs. 54.6 ± 3 cm/s, p = 0.01). No significant differences in CPP were observed within and between groups.
  
  
  CONCLUSIONS
  The quantitative evaluation of cerebral blood flow (CBF) and CVF and their postural dependency may be related to a dysfunction of autonomic nervous system that seems to characterize more disabled MS patients. It's not clear whether the altered postural control of arterial inflow and venous outflow is a specific MS condition or simply an "epiphenomenon" of neurodegenerative events.
authors.affiliation: Neurovascular Diagnosis Unit, Department of Medical and Surgical Sciences and Biotechnology - Section of Neurology, Sapienza, University of Rome, Rome, Italy; Department of Clinical Neurosciences, Neurological Centre of Latium - Institute of Neurosciences, Rome, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Marchione
authors.affiliation: Neurovascular Diagnosis Unit, Department of Medical and Surgical Sciences and Biotechnology - Section of Neurology, Sapienza, University of Rome, Rome, Italy; Multiple Sclerosis Center, Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Morreale
authors.affiliation: Neurovascular Diagnosis Unit, Department of Medical and Surgical Sciences and Biotechnology - Section of Neurology, Sapienza, University of Rome, Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Giacomini
authors.affiliation: Neurovascular Diagnosis Unit, Department of Medical and Surgical Sciences and Biotechnology - Section of Neurology, Sapienza, University of Rome, Rome, Italy; Department of Clinical Neurosciences, Neurological Centre of Latium - Institute of Neurosciences, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Izzo
authors.affiliation: Multiple Sclerosis Center, Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy; Istituto di Ricerca e Cura a Carattere Scientifico - Neuromed, Pozzilli (Isernia), Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Pontecorvo
authors.affiliation: Multiple Sclerosis Center, Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Altieri
authors.affiliation: Multiple Sclerosis Center, Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bernardi
authors.affiliation: Multiple Sclerosis Center, Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Frontoni
authors.affiliation: Multiple Sclerosis Center, Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome, Italy.
authors.forename: Ada
authors.initials: A
authors.lastname: Francia
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002550:Cerebral Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D014463:Ultrasonography