title: Jugular diameter and venous reflux.
abstract: OBJECTIVE
  Aims of this study were to investigate the prevalence of reflux on internal jugular veins(IJV) by Valsalva maneuver and to define the association between reflux of IJV in subjects with both CCSVI and MS.
  
  
  METHODS
  We recruited 393 patients with MS and CCSVI. Study participants underwent EchoColor Doppler exam in order to define IJV diameter at confluence in subclavian (JSd). Subjects were divided in three groups: group "1<JSd<6 mm" (subjects with jugular diameter less than 6mm); group "6≤JSd<10 mm" (subjects with jugular diameter equal or more than 6 but less than 10); and group "JSd≥10 mm" (subjects with jugular diameter equal or more than 10 mm).
  
  
  RESULTS
  In our sample the Jugular mean diameter was 8 ± 2 mm. There were not significant differences in mean diameter values in left/right jugular, after grouping jugular diameters into three groups by mean sample values ± standard deviation. Veins ≥10mm were more observed than veins ≤6 mm. Significant difference were found in male vs female prevalence of subject included in "JSd≥10 mm" (30.7% vs 16.7%. X2 =22.9622 with df=2 p<0.0001). Regarding the group "JSd≥10 mm", while in males the Valsalva+/Valsalva- ratio was about 1:3, in females the ratio was about 1:2. Female are more aged in "JSd≥10 mm" group vs female subjects in "1<JSd<6 mm" or "6≤JSd<10 mm" groups (p<0.05: Kruskal-Wallis H test = 8,0832 with df=2). Aged females have Jugular diameter larger than younger females.
  
  
  CONCLUSIONS
  By the analysis of the data, we may suppose that the females with both CCSVI and MS may present a wall Miopragia because there are significant differences in Valsalva+/ Valsalva- Ratio in females vs males subjects included in "JSd≥10 mm" group (about 1:2 vs. 1:3).r Moreover jugular dilatations are equally present in left and right side and it can confirm the wall Miopragia hypothesis. The prevalence of V+ maneuver grows with the IJV diameter, therefore we presume that IJV dilatation is linked with the presence of jugular reflux. Further studies are required to consolidate our observations.
  
  
  BACKGROUND
  CCSVI, Jugular vein diameter, Valsalva maneuver.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mandolesi
authors.forename: Alessandro
authors.initials: A
authors.lastname: d'Alessandro
authors.forename: Tarcisio
authors.initials: T
authors.lastname: Niglio
authors.forename: Aldo
authors.initials: A
authors.lastname: Bruno
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bernardo
authors.forename: Dimitri
authors.initials: D
authors.lastname: Mandolesi
authors.forename: Antonella
authors.initials: A
authors.lastname: Caroli
authors.forename: Aldo
authors.initials: A
authors.lastname: d'Alessandro
authors.forename: Francesco
authors.initials: F
authors.lastname: Fedele
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000473:pathology*; D008297:Male; D009103:Multiple Sclerosis / Q000503:physiopathology*; D009929:Organ Size; D012039:Regional Blood Flow; D013131:Spine / Q000098:blood supply; D014636:Valsalva Maneuver; D014689:Venous Insufficiency / Q000503:physiopathology*