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Taylor Z, English C, Cramberg M, Young BA. The influence of spinal venous blood pressure on cerebrospinal fluid pressure. Sci Rep 2023; 13:20989. [PMID: 38017027 PMCID: PMC10684553 DOI: 10.1038/s41598-023-48334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/25/2023] [Indexed: 11/30/2023] Open
Abstract
In Alligator mississippiensis the spinal dura is surrounded by a venous sinus; pressure waves can propagate in the spinal venous blood, and these spinal venous pressures can be transmitted to the spinal cerebrospinal fluid (CSF). This study was designed to explore pressure transfer between the spinal venous blood and the spinal CSF. At rest the cardiac-related CSF pulsations are attenuated and delayed, while the ventilatory-related pulsations are amplified as they move from the spinal venous blood to the spinal CSF. Orthostatic gradients resulted in significant alterations of both cardiac- and ventilatory-related CSF pulsations. Manual lateral oscillations of the alligator's tail created pressure waves in the spinal CSF that propagated, with slight attenuation but no delay, to the cranial CSF. Oscillatory pressure pulsations in the spinal CSF and venous blood had little influence on the underlying ventilatory pulsations, though the same oscillatory pulsations reduced the ventilatory- and increased the cardiac-related pulsations in the cranial CSF. In Alligator the spinal venous anatomy creates a more complex pressure relationship between the venous and CSF systems than has been described in humans.
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Affiliation(s)
- Z Taylor
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, MO, 63501, USA
| | - C English
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, MO, 63501, USA
| | - M Cramberg
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, MO, 63501, USA
| | - B A Young
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, MO, 63501, USA.
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Song SY, Lan D, Jiao BL, Liu YH, Ding YC, Ji XM, Meng R. The Negative Prognostic Role of Inflammatory Biomarkers in Patients With Chronic Cerebrospinal Venous Insufficiency. Neurologist 2023; 28:57-68. [PMID: 35697039 PMCID: PMC9977416 DOI: 10.1097/nrl.0000000000000443] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The pathologic consequences of inflammatory responses in chronic cerebrospinal venous insufficiency (CCSVI) remains poorly understood. Hence, this study was aimed to evaluate the peripheral inflammatory biomarkers in patients with intracranial and extracranial CCSVI pathology. In addition, the relationship between inflammatory cytokine profile and CCSVI prognosis was also evaluated. METHODS Patients diagnosed with CCSVI between July 2017 and July 2019 were included and subsequently divided into 3 groups based on the location of stenosis. The inflammatory biomarker assay included neutrophil-to-lymphocyte ratios (NLRs), platelet-to-lymphocyte ratios (PLRs), red blood cell distribution widths (RDW), C-reactive protein (CRP) levels, interleukin-6 (IL-6) levels, and neuron-specific enolase levels. Clinical outcomes were assessed using the modified Rankin Scale and Patient Global Impression of Change score. Univariate and multivariate regression analyses were performed to identify significant prognostic factors for poorer outcomes. Finally, we established a nomogram based on the multivariate regression analysis. RESULTS We enrolled 248 patients in total, including 102 males and 146 females, with an average age of 57.85±12.28 years. Compared with patients with internal jugular vein stenosis, cerebral venous sinus stenosis (CVSS) patients were mostly younger and had been suffering from headaches and severe papilledema. Higher levels of NLR, RDW, and CRP were also observed in the CVSS group. Multivariate analysis indicated that NLR, PLR, and IL-6 were the independent prognostic factors for poor CCSVI outcomes. CONCLUSIONS The clinical presentations and increases in NLR, PLR, IL-6, and CRP levels could be distinctly marked in patients with CVSS-related CCSVI than that in internal jugular vein stenosis-related CCSVI, indicating poor prognostic outcomes in these patients. A proinflammatory state might be associated with CCSVI pathology.
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Affiliation(s)
- Si-ying Song
- Departments of Neurology
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing
| | - Duo Lan
- Departments of Neurology
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing
| | - Bao-lian Jiao
- Departments of Neurology
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing
| | - Yun-huan Liu
- Departments of Neurology
- HuaDong Hospital, Fudan University, Shanghai, China
| | - Yu-chuan Ding
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI
| | - Xun-ming Ji
- Departments of Neurology
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing
| | - Ran Meng
- Departments of Neurology
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing
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3
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Hendriks T, Kirsch C, Gibson D, Kuthubutheen J. Temporal Bone Skull Base Defects-The Value and Importance of Early Based Detection to Prevent Late Costly Morbidity and Mortality. J Neurol Surg B Skull Base 2022; 83:653-662. [PMID: 36393874 PMCID: PMC9653295 DOI: 10.1055/a-1933-3958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/24/2022] [Indexed: 10/14/2022] Open
Affiliation(s)
- Thomas Hendriks
- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Australia
| | - Claudia Kirsch
- Yale University School of Medicine Department of Radiology and Biomedical Imaging, New Haven, Connecticut, United States
- Mount Sinai Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, United States
- Department of Clinical Dentistry, University of Sheffield, Sheffield, South Yorkshire, England
| | - Daren Gibson
- Department of Medical Imaging, Fiona Stanley Hospital Ringgold Standard Institution, Murdoch, Australia
| | - Jafri Kuthubutheen
- Department of Ear, Nose and Throat Surgery, Fiona Stanley Hospital Ringgold Standard Institution, Murdoch, Australia
- Department of Otolaryngology and Head and Neck Surgery, Sir Charles Gairdner Hospital Ringgold Standard Institution, Nedlands, Australia
- Department of Western ENT, South Perth Hospital, Como, Australia
- School of Surgery, The University of Western Australia Ringgold Standard Institution, Perth, Australia
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Results of Numerical Modeling of Blood Flow in the Internal Jugular Vein Exhibiting Different Types of Strictures. Diagnostics (Basel) 2022; 12:diagnostics12112862. [PMID: 36428922 PMCID: PMC9689302 DOI: 10.3390/diagnostics12112862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
The clinical relevance of nozzle-like strictures in upper parts of the internal jugular veins remains unclear. This study was aimed at understanding flow disturbances caused by such stenoses. Computational fluid dynamics software, COMSOL Multiphysics, was used. Two-dimensional computational domain involved stenosis at the beginning of modeled veins, and a flexible valve downstream. The material of the venous valve was considered to be hyperelastic. In the vein models with symmetric 2-leaflets valve without upstream stenosis or with minor 30% stenosis, the flow was undisturbed. In the case of major 60% and 75% upstream stenosis, centerline velocity was positioned asymmetrically, and areas of reverse flow and flow separation developed. In the 2-leaflet models with major stenosis, vortices evoking flow asymmetry were present for the entire course of the model, while the valve leaflets were distorted by asymmetric flow. Our computational fluid dynamics modeling suggests that an impaired outflow from the brain through the internal jugular veins is likely to be primarily caused by pathological strictures in their upper parts. In addition, the jugular valve pathology can be exacerbated by strictures located in the upper segments of these veins.
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Aglamis S, Gönen M. Flow volume measurement of arterial venous and cerebrospinal fluid in patients with multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:706-711. [PMID: 36254443 PMCID: PMC9685823 DOI: 10.1055/s-0042-1755276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Background Multiple sclerosis (MS) is usually described as an autoimmune disease, although the exact mechanism of the disease remains unknown. There have been studies reporting that venous flow abnormalities may be involved in the pathogenesis of MS or many of the associated clinical manifestations.
Objective The aim of this study was to evaluate flow volumes of the middle cerebral artery (MCA), transverse sinus (TS), and cerebral aqueduct using phase contrast magnetic resonance imaging (PC-MRI) in relapsing-remitting MS patients and a control group.
Methods We included 34 patients diagnosed by the McDonald criteria, revised in 2017, as well as 15 healthy controls matched by age and sex. The MRI scans were performed using a 1.5-T superconducting scanner. Axial T1-weighted, T2-weighted, and PC-MRI sequences were performed for the quantitative investigation of flow volume measurements. Quantitative analyses of flows were performed using flow analyses program PC-MRI angiography software. A circular region of interest was placed manually into the cerebral aqueduct, bilateral MCA, and TS.
Results Flow volumes of the cerebral aqueduct and MCA were not statistically significant between the MS and control groups. The flow volumes of the TS for the patient group were lower than those of the control group, and this difference was statistically significant.
Conclusions A reduced TS flow volume in MS patients was noted in the present study when compared with the control group, suggesting a relation between venous pathologies and MS. Further studies are needed to understand whether this relation is causal or epiphenomenal.
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Affiliation(s)
- Serpil Aglamis
- Firat University, Faculty of Medicine, Department of Radiology, Elazig, Turkey
| | - Murat Gönen
- Firat University, Faculty of Medicine, Department of Neurology, Elazig, Turkey
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Toro EF, Celant M, Zhang Q, Contarino C, Agarwal N, Linninger A, Müller LO. Cerebrospinal fluid dynamics coupled to the global circulation in holistic setting: Mathematical models, numerical methods and applications. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3532. [PMID: 34569188 PMCID: PMC9285081 DOI: 10.1002/cnm.3532] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
This paper presents a mathematical model of the global, arterio-venous circulation in the entire human body, coupled to a refined description of the cerebrospinal fluid (CSF) dynamics in the craniospinal cavity. The present model represents a substantially revised version of the original Müller-Toro mathematical model. It includes one-dimensional (1D), non-linear systems of partial differential equations for 323 major blood vessels and 85 zero-dimensional, differential-algebraic systems for the remaining components. Highlights include the myogenic mechanism of cerebral blood regulation; refined vasculature for the inner ear, the brainstem and the cerebellum; and viscoelastic, rather than purely elastic, models for all blood vessels, arterial and venous. The derived 1D parabolic systems of partial differential equations for all major vessels are approximated by hyperbolic systems with stiff source terms following a relaxation approach. A major novelty of this paper is the coupling of the circulation, as described, to a refined description of the CSF dynamics in the craniospinal cavity, following Linninger et al. The numerical solution methodology employed to approximate the hyperbolic non-linear systems of partial differential equations with stiff source terms is based on the Arbitrary DERivative Riemann problem finite volume framework, supplemented with a well-balanced formulation, and a local time stepping procedure. The full model is validated through comparison of computational results against published data and bespoke MRI measurements. Then we present two medical applications: (i) transverse sinus stenoses and their relation to Idiopathic Intracranial Hypertension; and (ii) extra-cranial venous strictures and their impact in the inner ear circulation, and its implications for Ménière's disease.
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Affiliation(s)
| | - Morena Celant
- Department of MathematicsUniversity of TrentoTrentoItaly
| | - Qinghui Zhang
- Laboratory of Applied Mathematics, DICAMUniversity of TrentoTrentoItaly
| | | | | | - Andreas Linninger
- Department of BioengineeringUniversity of Illinois at ChicagoChicagoIllinoisUSA
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7
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Beggs C, Tavoni V, Menegatti E, Tessari M, Ragazzi R, Malagoni AM, Giovanardi L. Spectral characteristics of the internal jugular vein and central venous pressure pulses: a proof of concept study. VEINS AND LYMPHATICS 2021. [DOI: 10.4081/vl.2021.9732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this proof-of-concept study the impact of central venous pressure (CVP) on internal jugular veins cross-sectional area (CSA) and blood flow time-average velocity (TAV) was evaluated in eight subjects, with the aim of understanding the drivers of the jugular venous pulse. CVP was measured using a central venous catheter while CSA variation and TAV along a cardiac cycle were acquired using ultrasound. Analysis of CVP, CSA and TAV time-series signals revealed TAV and CSA to lag behind CVP by on average 0.129 s and 0.138 s, with an inverse correlation between CSA and TAV (r= –0.316). The respective autocorrelation signals were strongly correlated (mean r=0.729-0.764), with mean CSA periodicity being 1.062 Hz. Fourier analysis revealed the frequency spectrums of CVP, TAV and CSA signals to be dominated by frequencies at approximately 1 and 2 Hz, with those >1 Hz greatly attenuated in the CSA signal. Because the autocorrelograms and periodograms of the respective signals were aligned and dominated by the same underlying frequencies, this suggested that they are more easily interpreted in the frequency domain rather than the time domain.
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8
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Predicting the Aqueductal Cerebrospinal Fluid Pulse: A Statistical Approach. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9102131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The cerebrospinal fluid (CSF) pulse in the Aqueduct of Sylvius (aCSF pulse) is often used to evaluate structural changes in the brain. Here we present a novel application of the general linear model (GLM) to predict the motion of the aCSF pulse. MR venography was performed on 13 healthy adults (9 female and 4 males—mean age = 33.2 years). Flow data was acquired from the arterial, venous and CSF vessels in the neck (C2/C3 level) and from the AoS. Regression analysis was undertaken to predict the motion of the aCSF pulse using the cervical flow rates as predictor variables. The relative contribution of these variables to predicting aCSF flow rate was assessed using a relative weights method, coupled with an ANOVA. Analysis revealed that the aCSF pulse could be accurately predicted (mean (SD) adjusted r2 = 0.794 (0.184)) using the GLM (p < 0.01). Venous flow rate in the neck was the strongest predictor of aCSF pulse (p = 0.001). In healthy individuals, the motion of the aCSF pulse can be predicted using the GLM. This indicates that the intracranial fluidic system has broadly linear characteristics. Venous flow in the neck is the strongest predictor of the aCSF pulse.
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9
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Markenroth Bloch K, Töger J, Ståhlberg F. Investigation of cerebrospinal fluid flow in the cerebral aqueduct using high-resolution phase contrast measurements at 7T MRI. Acta Radiol 2018; 59:988-996. [PMID: 29141450 DOI: 10.1177/0284185117740762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The cerebral aqueduct is a central conduit for cerebrospinal fluid (CSF), and non-invasive quantification of CSF flow in the aqueduct may be an important tool for diagnosis and follow-up of treatment. Magnetic resonance (MR) methods at clinical field strengths are limited by low spatial resolution. Purpose To investigate the feasibility of high-resolution through-plane MR flow measurements (2D-PC) in the cerebral aqueduct at high field strength (7T). Material and Methods 2D-PC measurements in the aqueduct were performed in nine healthy individuals at 7T. Measurement accuracy was determined using a phantom. Aqueduct area, mean velocity, maximum velocity, minimum velocity, net flow, and mean flow were determined using in-plane resolutions 0.8 × 0.8, 0.5 × 0.5, 0.3 × 0.3, and 0.2 × 0.2 mm2. Feasibility criteria were defined based on scan time and spatial and temporal resolution. Results Phantom validation of 2D-PC MR showed good accuracy. In vivo, stroke volume was -8.2 ± 4.4, -4.7 ± 2.8, -6.0 ± 3.8, and -3.7 ± 2.1 µL for 0.8 × 0.8, 0.5 × 0.5, 0.3 × 0.3, and 0.2 × 0.2 mm2, respectively. The scan with 0.3 × 0.3 mm2 resolution fulfilled the feasibility criteria for a wide range of heart rates and aqueduct diameters. Conclusion 7T MR enables non-invasive quantification of CSF flow and velocity in the cerebral aqueduct with high spatial resolution.
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Affiliation(s)
| | - Johannes Töger
- Department of Diagnostic Radiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Freddy Ståhlberg
- Department of Diagnostic Radiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
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10
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Spijkerman JM, Geurts LJ, Siero JCW, Hendrikse J, Luijten PR, Zwanenburg JJM. Phase contrast MRI measurements of net cerebrospinal fluid flow through the cerebral aqueduct are confounded by respiration. J Magn Reson Imaging 2018; 49:433-444. [PMID: 29741818 PMCID: PMC6519345 DOI: 10.1002/jmri.26181] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/19/2018] [Indexed: 11/15/2022] Open
Abstract
Background Net cerebrospinal fluid (CSF) flow through the cerebral aqueduct may serve as a marker of CSF production in the lateral ventricles, and changes that occur with aging and in disease. Purpose To investigate the confounding influence of the respiratory cycle on net CSF flow and stroke volume measurements. Study Type Cross‐sectional study. Subjects Twelve young, healthy subjects (seven male, age range 19–39 years, average age 28.3 years). Field Strength/Sequence Phase contrast MRI (PC‐MRI) measurements were performed at 7T, with and without respiratory gating on expiration and on inspiration. All measurements were repeated. Assessment Net CSF flow and stroke volume in the aqueduct, over the cardiac cycle, was determined. Statistical Tests Repeatability was determined using the intraclass correlation coefficient (ICC) and linear regression analysis between the repeated measurements. Repeated measures analysis of variance (ANOVA) was performed to compare the measurements during inspiration/expiration/no gating. Linear regression analysis was performed between the net CSF flow difference (inspiration minus expiration) and stroke volume. Results Net CSF flow (average ± standard deviation) was 0.64 ± 0.32 mL/min (caudal) during expiration, 0.12 ± 0.49 mL/min (cranial) during inspiration, and 0.31 ± 0.18 mL/min (caudal) without respiratory gating. Respiratory gating did not affect stroke volume measurements (41 ± 18, 42 ± 19, 42 ± 19 μL/cycle for expiration, no respiratory gating and inspiration, respectively). Repeatability was best during inspiration (ICC = 0.88/0.56/–0.31 for gating on inspiration/expiration/no gating). A positive association was found between average stroke volume and net flow difference between inspiration and expiration (R = 0.678/0.605, P = 0.015/0.037 for the first/second repeated measurement). Data Conclusion Measured net CSF flow is confounded by respiration effects. Therefore, net CSF flow measurements with PC‐MRI cannot in isolation be directly linked to CSF production. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:433–444.
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Affiliation(s)
- Jolanda M Spijkerman
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lennart J Geurts
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jeroen C W Siero
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.,Spinoza Center for Neuroimaging, Amsterdam, Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
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Zamboni P, Menegatti E, Cittanti C, Sisini F, Gianesini S, Salvi F, Mascoli F. Fixing the jugular flow reduces ventricle volume and improves brain perfusion. J Vasc Surg Venous Lymphat Disord 2018; 4:434-45. [PMID: 27638998 DOI: 10.1016/j.jvsv.2016.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 06/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Increased ventricle volume and brain hypoperfusion are linked to neurodegeneration. We hypothesized that in patients with restricted jugular flow, surgical restoration may reduce brain ventricle volume, because it should improve the pressure gradient, hence promoting cerebrospinal fluid reabsorption into the venous system. METHODS The effects of restoring the jugular flow were assessed by means of a validated echocardiography with color Doppler (ECD) protocol of flow quantification, magnetic resonance venography, and single-photon emission computed tomography combined with computed tomography (SPECT-CT). The main outcome measurement was the cerebral ventricle volume blindly assessed at SPECT-CT. Secondary outcomes were brain perfusion in the whole brain and in another 12 cerebral regions. The mean follow-up of the SPECT-CT and ECD parameters was 30 days. Patency rate was subsequently monitored by means of the same ECD protocol every 3 months. RESULTS Among 56 patients (28 male and 28 female; mean age, 44 ± 10 years) with ECD screening positive for chronic cerebrospinal venous insufficiency due to nonmobile jugular leaflets, 15 patients were excluded from the initial cohort because they did not meet the inclusion and exclusion criteria. Of the remaining 41 patients, 27 patients (14 male, 13 female; mean age, 48 ± 7 years) underwent endophlebectomy and autologous vein patch angioplasty. Omohyoid muscle section was performed when appropriate. The control group comprised 14 patients matched by age and gender (8 male, 6 female; mean age, 44 ± 11 years) who were not treated. Comorbidity was multiple sclerosis without significant differences in relapsing remitting (RR) and secondary progressive (SP) clinical course among groups. In the control group, neither ECD nor SPECT-CT showed any significant changes at follow-up. On the contrary, in the group operated on, the collateral flow index went from 70% to 30% (P < .0003) thanks to improved flow through the internal jugular vein. Correspondingly, ventricle volume dramatically decreased in the treated group (from 34 ± 14 cm(3) to 31 ± 13 cm(3); P < .01). The effect was much more evident in the RR subgroup (P = .009), whereas in the SP subgroup, it was not significant. Perfusion was found to be improved in the surgical group with respect to controls, particularly in the occipital and parietal regions of the RR subgroup (P < .0001 and P = .017, respectively), but not in the SP subgroup. The probability of reducing ventricle size is increased by 13-fold (P < .03) when restoration of the jugular flow achieves a postoperative collateral flow index ≤20%. Finally, the 18-month patency rate was 74%. CONCLUSIONS Fixing the flow in the jugulars in patients with chronic cerebrospinal venous insufficiency might significantly reduce brain ventricle volume and improve cerebral perfusion. These changes are more evident in patients in the earlier stages of neurodegenerative disease.
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Affiliation(s)
- Paolo Zamboni
- Unit of Translational Surgery, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy.
| | - Erica Menegatti
- Unit of Translational Surgery, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Corrado Cittanti
- Unit of Nuclear Medicine, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy
| | | | - Sergio Gianesini
- Unit of Translational Surgery, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy
| | | | - Francesco Mascoli
- Unit of Vascular Surgery, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy
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12
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Zhou D, Ding JY, Ya JY, Pan LQ, Yan F, Yang Q, Ding YC, Ji XM, Meng R. Understanding jugular venous outflow disturbance. CNS Neurosci Ther 2018; 24:473-482. [PMID: 29687619 DOI: 10.1111/cns.12859] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/17/2018] [Accepted: 03/18/2018] [Indexed: 12/11/2022] Open
Abstract
Extracranial venous abnormalities, especially jugular venous outflow disturbance, were originally viewed as nonpathological phenomena due to a lack of realization and exploration of their feature and clinical significance. The etiology and pathogenesis are still unclear, whereas a couple of causal factors have been conjectured. The clinical presentation of this condition is highly variable, ranging from insidious to symptomatic, such as headaches, dizziness, pulsatile tinnitus, visual impairment, sleep disturbance, and neck discomfort or pain. Standard diagnostic criteria are not available, and current diagnosis largely depends on a combinatory use of imaging modalities. Although few researches have been conducted to gain evidence-based therapeutic approach, several recent advances indicate that intravenous angioplasty in combination with stenting implantation may be a safe and efficient way to restore normal blood circulation, alleviate the discomfort symptoms, and enhance patients' quality of life. In addition, surgical removal of structures that constrain the internal jugular vein may serve as an alternative or adjunctive management when endovascular intervention is not feasible. Notably, discussion on every aspect of this newly recognized disease entity is in the infant stage and efforts with more rigorous designed, randomized controlled studies in attempt to identify the pathophysiology, diagnostic criteria, and effective approaches to its treatment will provide a profound insight into this issue.
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Affiliation(s)
- Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia-Yue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing-Yuan Ya
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li-Qun Pan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Yan
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu-Chuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xun-Ming Ji
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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13
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Gruszecki M, Lancaster G, Stefanovska A, Neary JP, Dech RT, Guminski W, Frydrychowski AF, Kot J, Winklewski PJ. Human subarachnoid space width oscillations in the resting state. Sci Rep 2018; 8:3057. [PMID: 29449606 PMCID: PMC5814422 DOI: 10.1038/s41598-018-21038-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/29/2018] [Indexed: 11/17/2022] Open
Abstract
Abnormal cerebrospinal fluid (CSF) pulsatility has been implicated in patients suffering from various diseases, including multiple sclerosis and hypertension. CSF pulsatility results in subarachnoid space (SAS) width changes, which can be measured with near-infrared transillumination backscattering sounding (NIR-T/BSS). The aim of this study was to combine NIR-T/BSS and wavelet analysis methods to characterise the dynamics of the SAS width within a wide range of frequencies from 0.005 to 2 Hz, with low frequencies studied in detail for the first time. From recordings in the resting state, we also demonstrate the relationships between SAS width in both hemispheres of the brain, and investigate how the SAS width dynamics is related to the blood pressure (BP). These investigations also revealed influences of age and SAS correlation on the dynamics of SAS width and its similarity with the BP. Combination of NIR-T/BSS and time-frequency analysis may open up new frontiers in the understanding and diagnosis of various neurodegenerative and ageing related diseases to improve diagnostic procedures and patient prognosis.
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Affiliation(s)
- Marcin Gruszecki
- Department of Radiology Informatics and Statistics, Medical University of Gdansk, Gdansk, Poland.
| | | | | | - J Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Ryan T Dech
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Wojciech Guminski
- Department of Computer Communications, Faculty of Electronics, Telecommunications and Informatics, Gdansk University of Technology, Gdansk, Poland
| | | | - Jacek Kot
- National Centre for Hyperbaric Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland
| | - Pawel J Winklewski
- Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland.,Department of Clinical Anatomy and Physiology, Pomeranian University of Slupsk, Slupsk, Poland
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14
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Beggs CB, Giaquinta A, Veroux M, De Marco E, Mociskyte D, Veroux P. Mid-term sustained relief from headaches after balloon angioplasty of the internal jugular veins in patients with multiple sclerosis. PLoS One 2018; 13:e0191534. [PMID: 29360844 PMCID: PMC5779669 DOI: 10.1371/journal.pone.0191534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/05/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Multiple sclerosis (MS) patients frequently suffer from headaches and fatigue, and many reports have linked headaches with intracranial and/or extracranial venous obstruction. We therefore designed a study involving MS patients diagnosed with obstructive disease of internal jugular veins (IJVs), with the aim of evaluating the impact of percutaneous transluminal angioplasty (PTA) on headache and fatigue indicators. METHODS 286 MS patients (175 relapsing remitting (RR), 75 secondary progressive (SP), and 36 primary progressive (PP)), diagnosed with obstructive disease of IJVs, underwent PTA of IJVs during the period 2011-2015. This included 113 headache positive patients (82 RR, 22 SP, and 9 PP) and 277 fatigue positive patients (167 RR, 74 SP, and 36 PP). Migraine Disability Assessment (MIDAS), and the Fatigue Severity Scale (FSS) were evaluated: before PTA; 3-months after PTA; and at final follow-up in 2017. Patients were evaluated with Doppler sonography of the IJVs at 1, 6 and 12 months after PTA and yearly thereafter. Non-parametric statistical analysis was performed using a combination of the Friedman test and Spearman correlation analysis. RESULTS With the exception of the PP patients there were significant reductions (all p < 0.001) in the MIDAS and FSS scores in the 3-month following PTA. The improvement in MIDAS score following PTA was maintained throughout the follow-up period in both the RR (p < 0.001; mean of 3.55 years) and SP (p = 0.002; mean of 3.52 years) MS cohorts. With FSS, significant improvement was only observed at 2017 follow-up in the RR patients (p < 0.001; mean of 3.37 years). In the headache-positive patients, post-PTA MIDAS score was significantly negatively correlated with the change in the blood flow score in the left (r = -0.238, p = 0.031) and right (r = -0.250, p = 0.023) IJVs in the RR patients and left IJV (r = -0.727, p = 0.026) in the PP patients. In the fatigue-positive cohort, post-PTA FSS score was also significantly negatively correlated with the change in blood flow in the right IJV in the PP patients (r = -0.423, p = 0.010). In addition, the pre and post-PTA FSS scores were significantly positively correlated in the fatigue-positive RR (r = 0.249, p = 0.001) and SP patients (r = 0.272, p = 0.019). CONCLUSIONS The intervention of PTA was associated with a large and sustained (>3 years) reduction in MIDAS score in both RR and SP MS patients. While a similar initial post-PTA reduction in FSS score was also observed, this was not maintained in the SP and PP patients, although it remained significant at follow-up (>3 years) in the RR MS patients. This suggests that venoplasty might be a useful intervention for treating patients with persistent headaches and selected concomitant obstructive disease of the IJVs.
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Affiliation(s)
- Clive B. Beggs
- Institute for Sport, Physical Activity and Leisure, School of Sport, Leeds Beckett University, Leeds, United Kingdom
| | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
| | - Ester De Marco
- Vascular Surgery and Organ Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
| | - Dovile Mociskyte
- Vascular Surgery and Organ Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, Catania, Italy
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15
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Gruszecki M, Nuckowska MK, Szarmach A, Radkowski M, Szalewska D, Waskow M, Szurowska E, Frydrychowski AF, Demkow U, Winklewski PJ. Oscillations of Subarachnoid Space Width as a Potential Marker of Cerebrospinal Fluid Pulsatility. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1070:37-47. [PMID: 29435957 DOI: 10.1007/5584_2018_155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the cerebrospinal fluid (CSF) circulation, two components can be distinguished: bulk flow (circulation) and pulsatile flow (back and forth motion). CSF pulsatile flow is generated by both cardiac and respiratory cycles. Recent years have seen increased interest in cardiac- and respiratory-driven CSF pulsatility as an important component of cerebral homeostasis. CSF pulsatility is affected by cerebral arterial inflow and jugular outflow and potentially linked to white matter abnormalities in various diseases, such as multiple sclerosis or hypertension. In this review, we discuss the physiological mechanisms associated with CSF pulsation and its clinical significance. Finally, we explain the concept of using the oscillations of subarachnoid space width as a surrogate for CSF pulsatility.
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Affiliation(s)
- Marcin Gruszecki
- Department of Radiology Informatics and Statistics, Medical University of Gdansk, Gdansk, Poland
| | | | - Arkadiusz Szarmach
- Second Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Marek Radkowski
- Department of Immunopathology of Infectious and Parasitic Diseases, Warsaw Medical University, Warsaw, Poland
| | - Dominika Szalewska
- Chair of Rehabilitation Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Monika Waskow
- Faculty of Health Sciences, Slupsk Pomeranian University, Slupsk, Poland
| | - Edyta Szurowska
- Second Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | | | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Warsaw Medical University, Warsaw, Poland
| | - Pawel J Winklewski
- Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland.
- Second Department of Radiology, Medical University of Gdansk, Gdansk, Poland.
- Faculty of Health Sciences, Slupsk Pomeranian University, Slupsk, Poland.
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16
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Ragunathan S, Pipe JG. Radiofrequency saturation induced bias in aqueductal cerebrospinal fluid flow quantification obtained using two-dimensional cine phase contrast magnetic resonance imaging. Magn Reson Med 2017; 79:2067-2076. [PMID: 28833454 DOI: 10.1002/mrm.26883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE To explore the extent of bias in cerebrospinal fluid flow estimates due to radiofrequency saturation, and its possible impact on the use of two-dimensional cine phase contrast magnetic resonance imaging in the diagnosis and characterization of normal pressure hydrocephalus in patients. THEORY AND METHODS Theoretical signal equations were generated to describe saturation dependence on velocity. An experimental set of phase contrast magnetic resonance imaging scans with two different flip angles was used to show bias in flow estimates in a flow phantom, and in six different healthy volunteers. The cerebral aqueduct was targeted as the flow region of interest. RESULTS Data from a constant flow phantom showed a spatial distribution of voxels with significant bias in flow at the periphery of the flow region. The velocity difference (bias) maps of the cerebral aqueduct correlated with the spatial velocity gradients around peak systole and peak diastole, and high correlation with temporal velocity gradients during transition between systole and diastole. The aqueductal stroke volume for θ = 30° were found to be significantly higher than for θ = 10° using a Wilcoxon signed rank test. CONCLUSION This work shows the extent of bias in cerebrospinal fluid flow quantification due to radiofrequency saturation effects. This clinical relevance of this error was presented with respect to shunt responsiveness among normal pressure hydrocephalus patients. Magn Reson Med 79:2067-2076, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
| | - James G Pipe
- Barrow Neurological Institute, Imaging Research, Phoenix, Arizona, USA
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17
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Intracranial volumetric changes govern cerebrospinal fluid flow in the Aqueduct of Sylvius in healthy adults. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2017.03.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Wszedybyl-Winklewska M, Wolf J, Swierblewska E, Kunicka K, Mazur K, Gruszecki M, Winklewski PJ, Frydrychowski AF, Bieniaszewski L, Narkiewicz K. Increased inspiratory resistance affects the dynamic relationship between blood pressure changes and subarachnoid space width oscillations. PLoS One 2017; 12:e0179503. [PMID: 28654638 PMCID: PMC5487010 DOI: 10.1371/journal.pone.0179503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 05/31/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Respiration is known to affect cerebrospinal fluid (CSF) movement. We hypothesised that increased inspiratory resistance would affect the dynamic relationship between blood pressure (BP) changes and subarachnoid space width (SAS) oscillations. METHODS Experiments were performed in a group of 20 healthy volunteers undergoing controlled intermittent Mueller Manoeuvres (the key characteristic of the procedure is that a studied person is subjected to a controlled, increased inspiratory resistance which results in marked potentiation of the intrathoracic negative pressure). BP and heart rate (HR) were measured using continuous finger-pulse photoplethysmography; oxyhaemoglobin saturation with an ear-clip sensor; end-tidal CO2 with a gas analyser; cerebral blood flow velocity (CBFV), pulsatility and resistive indices with Doppler ultrasound. Changes in SAS were recorded with a new method i.e. near-infrared transillumination/backscattering sounding. Wavelet transform analysis was used to assess the BP and SAS oscillations coupling. RESULTS Initiating Mueller manoeuvres evoked cardiac SAS component decline (-17.8%, P<0.001), systolic BP, diastolic BP and HR increase (+6.3%, P<0.001; 6.7%, P<0.001 and +2.3%, P<0.05, respectively). By the end of Mueller manoeuvres, cardiac SAS component and HR did not change (+2.3% and 0.0%, respectively; both not statistically significant), but systolic and diastolic BP was elevated (+12.6% and +8.9%, respectively; both P<0.001). With reference to baseline values there was an evident decrease in wavelet coherence between BP and SAS oscillations at cardiac frequency in the first half of the Mueller manoeuvres (-32.3%, P<0.05 for left hemisphere and -46.0%, P<0.01 for right hemisphere) which was followed by subsequent normalization at end of the procedure (+3.1% for left hemisphere and +23.1% for right hemisphere; both not statistically significant). CONCLUSIONS Increased inspiratory resistance is associated with swings in the cardiac contribution to the dynamic relationship between BP and SAS oscillations. Impaired cardiac performance reported in Mueller manoeuvres may influence the pattern of cerebrospinal fluid pulsatility.
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Affiliation(s)
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
- Department of Cardiovascular Diseases, International Clinical Research Center, St. Anne’s University Hospital in Brno (FNUSA), Brno, Czech Republic
| | - Ewa Swierblewska
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Kunicka
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Kamila Mazur
- Department of Biomedical Engineering, Faculty of Electronics, Telecommunications and Informatics, Gdansk University of Technology, Gdansk, Poland
| | - Marcin Gruszecki
- Department of Radiology Informatics and Statistics, Medical University of Gdansk, Gdansk, Poland
| | - Pawel J. Winklewski
- Institute of Human Physiology, Medical University of Gdansk, Gdansk, Poland
- Institute of Health Sciences, Pomeranian University of Slupsk, Slupsk, Poland
| | | | | | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
- Department of Cardiovascular Diseases, International Clinical Research Center, St. Anne’s University Hospital in Brno (FNUSA), Brno, Czech Republic
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19
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Oner Z, Sagіr Kahraman A, Kose E, Oner S, Kavaklі A, Cay M, Ozbag D. Quantitative Evaluation of Normal Aqueductal Cerebrospinal Fluid Flow Using Phase-Contrast Cine MRI According to Age and Sex. Anat Rec (Hoboken) 2016; 300:549-555. [PMID: 27863121 DOI: 10.1002/ar.23514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 11/06/2022]
Abstract
The aim of this study was cerebrospinal fluid (CSF) flow quantification in the cerebral aqueduct using phase-contrast cine magnetic resonance ımaging (PCC-MRI) according to both sexes and three different age groups to obtain normative data. Seventy two volunteers with no cerebral pathology were included in this study. Subjects were divided into three age groups: 20-34 years, 35-49 years, and 50-65 years including equal gender groups. CSF flow's quantitatively evaluation was performed with images that were obtained by 1.5 T Magnetic Resonance (MR) unit from cerebral aqueduct level on the semi-axial plan. Between groups, peak velocity (cm sec-1 ), average velocity (cm/s), forward volume (mL), reverse volume (mL), net forward volume (mL), and average flow over range (ml/min) values of current flowing through aqueduct and average aqueductal areas were compared. There were no statistically significant differences in CSF flow parameters among different age groups and between sexes (P > 0.05). There was a statistically significant difference in average cerebral aqueduct area between the age group of 50-65 years and the other age groups (P = 0.002). The average aqueductal area was higher in the age group of 50-65 years. Normal aqueductal CSF flow parameters evaluated with PCC-MRI don't show a significant difference by age and sex. We have achieved the lower and upper values of these parameters would be useful in future clinical studies. The size of aqueductal area may also be explained by atrophy-dependent ventricular system dilatation in the elderly. Anat Rec, 300:549-555, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Zulal Oner
- Department of Anatomy, Karabük University, Karabük, Turkey
| | | | - Evren Kose
- Department of Anatomy, İnönü University, Malatya, Turkey
| | - Serkan Oner
- Department of Radiology, Karabük University, Karabük, Turkey
| | - Ahmet Kavaklі
- Department of Anatomy, Fırat University, Elazığ, Turkey
| | - Mahmut Cay
- Department of Anatomy, İnönü University, Malatya, Turkey
| | - Davut Ozbag
- Department of Anatomy, İnönü University, Malatya, Turkey
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20
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Belov P, Magnano C, Krawiecki J, Hagemeier J, Bergsland N, Beggs C, Zivadinov R. Age-related brain atrophy may be mitigated by internal jugular vein enlargement in male individuals without neurologic disease. Phlebology 2016; 32:125-134. [PMID: 26911619 DOI: 10.1177/0268355516633610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives To assess the relationship between cross-sectional area of internal jugular veins and brain volumes in healthy individuals without neurologic disease. Methods A total of 193 healthy individuals without neurologic disease (63 male and 130 female; age > 20 to < 70 years) received magnetic resonance venography and structural brain magnetic resonance imaging at 3T. The internal jugular vein cross-sectional area was assessed at C2-C3, C4, C5-C6, and C7-T1. Normalized whole brain volume was assessed. Partial correlation analyses were used to determine associations. Results There was an inverse relationship between normalized whole brain volume and total internal jugular vein cross-sectional area (C7-T1: males r = -0.346, p = 0.029; females r = -0.301, p = 0.002). After age adjustment, association of normalized whole brain volume and normalized gray matter volume with internal jugular vein cross-sectional area became positive in males (normalized whole brain volume and right internal jugular vein cross-sectional area (C2-C3) changed from r = -0.163 to r = 0.384, p = 0.002), but not in the females. Conclusion Sex differences exist in the relationship between brain volume and internal jugular vein cross-sectional area in healthy individuals without neurologic disease.
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Affiliation(s)
- Pavel Belov
- 1 Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Christopher Magnano
- 1 Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.,2 MRI Clinical and Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jacqueline Krawiecki
- 1 Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jesper Hagemeier
- 1 Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Niels Bergsland
- 1 Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.,3 IRCCS "S.Maria Nascente," Don Gnocchi Foundation, Milan, Italy
| | - Clive Beggs
- 1 Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.,4 Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - Robert Zivadinov
- 1 Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.,2 MRI Clinical and Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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21
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Till K, Jones BL, Cobley S, Morley D, O'Hara J, Chapman C, Cooke C, Beggs CB. Identifying Talent in Youth Sport: A Novel Methodology Using Higher-Dimensional Analysis. PLoS One 2016; 11:e0155047. [PMID: 27224653 PMCID: PMC4880304 DOI: 10.1371/journal.pone.0155047] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/22/2016] [Indexed: 11/23/2022] Open
Abstract
Prediction of adult performance from early age talent identification in sport remains difficult. Talent identification research has generally been performed using univariate analysis, which ignores multivariate relationships. To address this issue, this study used a novel higher-dimensional model to orthogonalize multivariate anthropometric and fitness data from junior rugby league players, with the aim of differentiating future career attainment. Anthropometric and fitness data from 257 Under-15 rugby league players was collected. Players were grouped retrospectively according to their future career attainment (i.e., amateur, academy, professional). Players were blindly and randomly divided into an exploratory (n = 165) and validation dataset (n = 92). The exploratory dataset was used to develop and optimize a novel higher-dimensional model, which combined singular value decomposition (SVD) with receiver operating characteristic analysis. Once optimized, the model was tested using the validation dataset. SVD analysis revealed 60 m sprint and agility 505 performance were the most influential characteristics in distinguishing future professional players from amateur and academy players. The exploratory dataset model was able to distinguish between future amateur and professional players with a high degree of accuracy (sensitivity = 85.7%, specificity = 71.1%; p<0.001), although it could not distinguish between future professional and academy players. The validation dataset model was able to distinguish future professionals from the rest with reasonable accuracy (sensitivity = 83.3%, specificity = 63.8%; p = 0.003). Through the use of SVD analysis it was possible to objectively identify criteria to distinguish future career attainment with a sensitivity over 80% using anthropometric and fitness data alone. As such, this suggests that SVD analysis may be a useful analysis tool for research and practice within talent identification.
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Affiliation(s)
- Kevin Till
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, West Yorkshire, United Kingdom
| | - Ben L. Jones
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, West Yorkshire, United Kingdom
| | - Stephen Cobley
- Discipline of Exercise & Sport Science, Faculty of Health Sciences, The University of Sydney, New South Wales, Australia
| | - David Morley
- Liverpool John Moores University, Liverpool, United Kingdom
| | - John O'Hara
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, West Yorkshire, United Kingdom
| | | | | | - Clive B. Beggs
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, West Yorkshire, United Kingdom
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
- * E-mail:
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22
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Beggs CB, Magnano C, Belov P, Krawiecki J, Ramasamy DP, Hagemeier J, Zivadinov R. Internal Jugular Vein Cross-Sectional Area and Cerebrospinal Fluid Pulsatility in the Aqueduct of Sylvius: A Comparative Study between Healthy Subjects and Multiple Sclerosis Patients. PLoS One 2016; 11:e0153960. [PMID: 27135831 PMCID: PMC4852898 DOI: 10.1371/journal.pone.0153960] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 04/06/2016] [Indexed: 12/25/2022] Open
Abstract
Objectives Constricted cerebral venous outflow has been linked with increased cerebrospinal fluid (CSF) pulsatility in the aqueduct of Sylvius in multiple sclerosis (MS) patients and healthy individuals. This study investigates the relationship between CSF pulsatility and internal jugular vein (IJV) cross-sectional area (CSA) in these two groups, something previously unknown. Methods 65 relapsing-remitting MS patients (50.8% female; mean age = 43.8 years) and 74 healthy controls (HCs) (54.1% female; mean age = 43.9 years) were investigated. CSF flow quantification was performed on cine phase-contrast MRI, while IJV-CSA was calculated using magnetic resonance venography. Statistical analysis involved correlation, and partial least squares correlation analysis (PLSCA). Results PLSCA revealed a significant difference (p<0.001; effect size = 1.072) between MS patients and HCs in the positive relationship between CSF pulsatility and IJV-CSA at C5-T1, something not detected at C2-C4. Controlling for age and cardiovascular risk factors, statistical trends were identified in HCs between: increased net positive CSF flow (NPF) and increased IJV-CSA at C5-C6 (left: r = 0.374, p = 0.016; right: r = 0.364, p = 0.019) and C4 (left: r = 0.361, p = 0.020); and increased net negative CSF flow and increased left IJV-CSA at C5-C6 (r = -0.348, p = 0.026) and C4 (r = -0.324, p = 0.039), whereas in MS patients a trend was only identified between increased NPF and increased left IJV-CSA at C5-C6 (r = 0.351, p = 0.021). Overall, correlations were weaker in MS patients (p = 0.015). Conclusions In healthy adults, increased CSF pulsatility is associated with increased IJV-CSA in the lower cervix (independent of age and cardiovascular risk factors), suggesting a biomechanical link between the two. This relationship is altered in MS patients.
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Affiliation(s)
- Clive B. Beggs
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- Research Institute for Sport, Physical Activity and Leisure, Carnegie Faculty, Leeds Beckett University, Leeds, West Yorkshire, United Kingdom
- * E-mail:
| | - Christopher Magnano
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- MRI Clinical Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Pavel Belov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Jacqueline Krawiecki
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Deepa P. Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- MRI Clinical Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- MRI Clinical Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
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23
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Mancini M, Greco A, Tedeschi E, Palma G, Ragucci M, Bruzzone MG, Coda ARD, Torino E, Scotti A, Zucca I, Salvatore M. Head and Neck Veins of the Mouse. A Magnetic Resonance, Micro Computed Tomography and High Frequency Color Doppler Ultrasound Study. PLoS One 2015; 10:e0129912. [PMID: 26067061 PMCID: PMC4466257 DOI: 10.1371/journal.pone.0129912] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/14/2015] [Indexed: 11/19/2022] Open
Abstract
To characterize the anatomy of the venous outflow of the mouse brain using different imaging techniques. Ten C57/black male mice (age range: 7-8 weeks) were imaged with high-frequency Ultrasound, Magnetic Resonance Angiography and ex-vivo Microcomputed tomography of the head and neck. Under general anesthesia, Ultrasound of neck veins was performed with a 20MHz transducer; head and neck Magnetic Resonance Angiography data were collected on 9.4T or 7T scanners, and ex-vivo Microcomputed tomography angiography was obtained by filling the vessels with a radiopaque inert silicone rubber compound. All procedures were approved by the local ethical committee. The dorsal intracranial venous system is quite similar in mice and humans. Instead, the mouse Internal Jugular Veins are tiny vessels receiving the sigmoid sinuses and tributaries from cerebellum, occipital lobe and midbrain, while the majority of the cerebral blood, i.e. from the olfactory bulbs and fronto-parietal lobes, is apparently drained through skull base connections into the External Jugular Vein. Three main intra-extracranial anastomoses, absent in humans, are: 1) the petrosquamous sinus, draining into the posterior facial vein, 2) the veins of the olfactory bulb, draining into the superficial temporal vein through a foramen of the frontal bone 3) the cavernous sinus, draining in the External Jugular Vein through a foramen of the sphenoid bone. The anatomical structure of the mouse cranial venous outflow as depicted by Ultrasound, Microcomputed tomography and Magnetic Resonance Angiography is different from humans, with multiple connections between intra- and extra- cranial veins.
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Affiliation(s)
- Marcello Mancini
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
- * E-mail:
| | - Adelaide Greco
- Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
- CEINGE-Biotecnologie Avanzate, Naples, Italy
| | - Enrico Tedeschi
- Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Giuseppe Palma
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Monica Ragucci
- Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Maria Grazia Bruzzone
- Unit of Neuroradiology, IRCCS Foundation “Carlo Besta” Neurological Institute, Milan, Italy
| | | | - Enza Torino
- Center for Advanced Biomaterials for Health Care@CRIB, Istituto Italiano di Tecnologia, Naples, Italy
| | - Alessandro Scotti
- Scientific Direction, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Ileana Zucca
- Scientific Direction, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
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Beggs CB, Magnano C, Shepherd SJ, Belov P, Ramasamy DP, Hagemeier J, Zivadinov R. Dirty-Appearing White Matter in the Brain is Associated with Altered Cerebrospinal Fluid Pulsatility and Hypertension in Individuals without Neurologic Disease. J Neuroimaging 2015; 26:136-43. [DOI: 10.1111/jon.12249] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/04/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Clive B. Beggs
- Centre for Infection Control and Biophysics; University of Bradford; Bradford UK
- Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences; University at Buffalo; Buffalo NY
| | - Christopher Magnano
- Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences; University at Buffalo; Buffalo NY
- MRI Clinical Translational Research Center, School of Medicine and Biomedical Sciences; University at Buffalo; Buffalo NY
| | - Simon J. Shepherd
- Centre for Infection Control and Biophysics; University of Bradford; Bradford UK
| | - Pavel Belov
- Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences; University at Buffalo; Buffalo NY
| | - Deepa P. Ramasamy
- Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences; University at Buffalo; Buffalo NY
- MRI Clinical Translational Research Center, School of Medicine and Biomedical Sciences; University at Buffalo; Buffalo NY
| | - Jesper Hagemeier
- Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences; University at Buffalo; Buffalo NY
| | - Robert Zivadinov
- Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences; University at Buffalo; Buffalo NY
- MRI Clinical Translational Research Center, School of Medicine and Biomedical Sciences; University at Buffalo; Buffalo NY
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25
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Zivadinov R. Is there a link between the extracranial venous system and central nervous system pathology? BMC Med 2013; 11:259. [PMID: 24344725 PMCID: PMC3866248 DOI: 10.1186/1741-7015-11-259] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 11/12/2022] Open
Abstract
The extracranial venous system is complex and variable between individuals. Until recently, these variations were acknowledged as developmental variants and were not considered pathological findings. However, in the last decade, the presence and severity of uni- or bi-lateral jugular venous reflux (JVR) was linked to several central nervous system (CNS) disorders such as transient global amnesia, transient monocular blindness, cough headache, primary exertional headache and, most recently, to Alzheimer's disease. The most recent introduction of a composite criteria-based vascular condition named chronic cerebrospinal venous insufficiency (CCSVI), which was originally linked to multiple sclerosis, increased the interest in better understanding the role of the extracranial venous system in the pathophysiology of CNS disorders. The ultimate cause-consequence relationship between these conditions and CNS disorders has not been firmly established and further research is needed. The purpose of this article collection in BMC Medicine and BMC Neurology is to synthesize current concepts and most recent findings concerning the evaluation, etiology, pathophysiology and clinical relevance of the potential involvement of the extracranial venous system in the pathology of multiple CNS disorders and in aging.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
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26
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Zivadinov R, Chung CP. Potential involvement of the extracranial venous system in central nervous system disorders and aging. BMC Med 2013; 11:260. [PMID: 24344742 PMCID: PMC3866257 DOI: 10.1186/1741-7015-11-260] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 11/22/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The role of the extracranial venous system in the pathology of central nervous system (CNS) disorders and aging is largely unknown. It is acknowledged that the development of the venous system is subject to many variations and that these variations do not necessarily represent pathological findings. The idea has been changing with regards to the extracranial venous system. DISCUSSION A range of extracranial venous abnormalities have recently been reported, which could be classified as structural/morphological, hemodynamic/functional and those determined only by the composite criteria and use of multimodal imaging. The presence of these abnormalities usually disrupts normal blood flow and is associated with the development of prominent collateral circulation. The etiology of these abnormalities may be related to embryologic developmental arrest, aging or other comorbidities. Several CNS disorders have been linked to the presence and severity of jugular venous reflux. Another composite criteria-based vascular condition named chronic cerebrospinal venous insufficiency (CCSVI) was recently introduced. CCSVI is characterized by abnormalities of the main extracranial cerebrospinal venous outflow routes that may interfere with normal venous outflow. SUMMARY Additional research is needed to better define the role of the extracranial venous system in relation to CNS disorders and aging. The use of endovascular treatment for the correction of these extracranial venous abnormalities should be discouraged, until potential benefit is demonstrated in properly-designed, blinded, randomized and controlled clinical trials.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
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