Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis.
Paolo Zamboni,Roberto Galeotti,Erica Menegatti,Anna Maria Malagoni,Giovanna Tacconi,Ilaria Bartolomei,Fabrizio Salvi +6 more
TLDR
CDMS is strongly associated with CCSVI, a scenario that has not previously been described, characterised by abnormal venous haemodynamics determined by extracranial multiple venous strictures of unknown origin.Abstract:
Background: The extracranial venous outflow routes in clinically defined multiple sclerosis (CDMS) have not previously been investigated. Methods: Sixty-five patients affected by CDMS, and 235 controls composed, respectively, of healthy subjects, healthy subjects older than CDMS patients, patients affected by other neurological diseases and older controls not affected by neurological diseases but scheduled for venography (HAV-C) blindly underwent a combined transcranial and extracranial colour-Doppler high-resolution examination (TCCS-ECD) aimed at detecting at least two of five parameters of anomalous venous outflow. According to the TCCS-ECD screening, patients and HAVC further underwent selective venography of the azygous and jugular venous system with venous pressure measurement. Results: CDMS and TCCS-ECD venous outflow anomalies were dramatically associated (OR 43, 95% CI 29 to 65, p,0.0001). Subsequently, venography demonstrated in CDMS, and not in controls, the presence of multiple severe extracranial stenosis, affecting the principal cerebrospinal venous segments; this provides a picture of chronic cerebrospinal venous insufficiency (CCSVI) with four different patterns of distribution of stenosis and substitute circle. Moreover, relapsing-remitting and secondary progressive courses were associated with CCSVI patterns significantly different from those of primary progressive (p,0.0001). Finally, the pressure gradient measured across the venous stenosies was slightly but significantly higher. Conclusion: CDMS is strongly associated with CCSVI, a scenario that has not previously been described, characterised by abnormal venous haemodynamics determined by extracranial multiple venous strictures of unknown origin. The location of venous obstructions plays a key role in determining the clinical course of the disease.read more
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Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses.
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A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency
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No Cerebrocervical Venous Congestion in Patients with Multiple Sclerosis
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TL;DR: Multiple sclerosis (MS) is characterized by demyelination centered around cerebral veins, and recent studies suggested this topographic pattern may be caused by venous congestion, a condition termed chronic cerebrospinal venous insufficiency (CCSVI).
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References
More filters
Journal ArticleDOI
Rating neurologic impairment in multiple sclerosis An expanded disability status scale (EDSS)
TL;DR: A new Expanded Disability Status Scale (EDSS) is presented, with each of the former steps (1,2,3 … 9) now divided into two (1.0, 1.5, 2.0 … 9).
Journal ArticleDOI
Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria".
Chris H. Polman,Stephen C. Reingold,Gilles Edan,Massimo Filippi,Hans-Peter Hartung,Ludwig Kappos,Fred D. Lublin,Luanne M. Metz,Henry F. McFarland,Paul O'Connor,Magnhild Sandberg-Wollheim,Alan J. Thompson,Brian G. Weinshenker,Jerry S. Wolinsky +13 more
TL;DR: New evidence and consensus now strengthen the role of these criteria in the multiple sclerosis diagnostic workup to demonstrate dissemination of lesions in time, to clarify the use of spinal cord lesions, and to simplify diagnosis of primary progressive disease.
Journal ArticleDOI
Defining the clinical course of multiple sclerosis Results of an international survey
TL;DR: An international survey of clinicians involved with MS revealed areas of consensus about some terms classically used to describe types of the disease and other areas for which there was lack of consensus and proposed standardized definitions for the most common clinical courses of patients with MS.
Journal ArticleDOI
Diagnostic criteria for multiple sclerosis.
Charles M. Poser,Vesna V. Brinar +1 more
TL;DR: The history of clinical diagnostic criteria demonstrates the evolution from rather tentative classifications of restricted value to the more elaborate 1983 scheme which incorporates some laboratory procedures under the rubric paraclinical tests as well as a new category based on the presence of specific abnormalities of the cerebrospinal fluid (CSF).
Journal ArticleDOI
Multiple Sclerosis — The Plaque and Its Pathogenesis
TL;DR: This review focuses on the current knowledge of the pathogenesis of the inflammatory and neurodegenerative elements of the multiple sclerosis plaque.