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Prajjwal P, Shree A, Das S, Inban P, Ghosh S, Senthil A, Gurav J, Kundu M, Marsool Marsool MD, Gadam S, Marsool Marsoo AD, Vora N, Amir Hussin O. Vascular multiple sclerosis: addressing the pathogenesis, genetics, pro-angiogenic factors, and vascular abnormalities, along with the role of vascular intervention. Ann Med Surg (Lond) 2023; 85:4928-4938. [PMID: 37811110 PMCID: PMC10553029 DOI: 10.1097/ms9.0000000000001177] [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: 05/27/2023] [Accepted: 08/05/2023] [Indexed: 10/10/2023] Open
Abstract
Dysfunction in the epithelium, breakdown of the blood-brain barrier, and consequent leukocyte and T-cell infiltration into the central nervous system define Vascular Multiple Sclerosis. Multiple sclerosis (MS) affects around 2.5 million individuals worldwide, is the leading cause of neurological impairment in young adults, and can have a variety of progressions and consequences. Despite significant discoveries in immunology and molecular biology, the root cause of MS is still not fully understood, as do the immunological triggers and causative pathways. Recent research into vascular anomalies associated with MS suggests that a vascular component may be pivotal to the etiology of MS, and there can be actually a completely new entity in the already available classification of MS, which can be called 'vascular multiple sclerosis'. Unlike the usual other causes of MS, vascular MS is not dependent on autoimmune pathophysiologic mechanisms, instead, it is caused due to the blood vessels pathology. This review aims to thoroughly analyze existing information and updates about the scattered available findings of genetics, pro-angiogenetic factors, and vascular abnormalities in this important spectrum, the vascular facets of MS.
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Affiliation(s)
| | - Anagha Shree
- SGT Medical College Hospital and Research Institute, Gurgaon
| | - Soumyajit Das
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar
| | - Pugazhendi Inban
- Internal Medicine, Government Medical College, Omandurar, Chennai
| | | | | | | | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar
| | | | - Srikanth Gadam
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Neel Vora
- Internal Medicine, B.J. Medical College, Ahmedabad, India
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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: 2] [Impact Index Per Article: 2.0] [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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Adachi U, Toi S, Hosoya M, Hoshino T, Seki M, Yoshizawa H, Tsutsumi Y, Maruyama K, Kitagawa K. Association of Age-Related Spontaneous Internal Jugular Vein Reflux with Cognitive Impairment and Incident Dementia. J Alzheimers Dis 2023; 96:1221-1230. [PMID: 37927264 DOI: 10.3233/jad-230771] [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] [Indexed: 11/07/2023]
Abstract
BACKGROUND It remains unclear whether changes in the venous circulation contribute to cognitive decline. OBJECTIVE This study aimed to clarify whether the spontaneous jugular vein reflux (JVR) is associated with cognitive impairment and incident dementia. METHODS Patients with any evidence of cerebral vessel disease on magnetic resonance imaging (MRI) were consecutively enrolled between October 2015 to July 2019. We employed carotid duplex sonography to measure the internal jugular vein (IJV). The subjects were classified into two groups based on the degree of JVR on either side: none, mild (JVR(-) group) and moderate, severe (JVR (+) group) JVR. They underwent both the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Japanese (MoCA-J) global tests. Their cognitive status was prospectively assessed until March 2023. RESULTS 302 patients with an MMSE score ≥24 underwent duplex sonography of the IJV. Among them, 91 had spontaneous JVR on either side. Both MMSE and MoCA-J were significantly lower in patients with JVR (+) group than in the JVR (-) group. After the adjustment for risk factors and MRI findings, intergroup differences in MoCA-J remained significant. Among the cognitive subdomains, median executive function and memory scores were significantly lower in the JVR (+) group than in the JVR (-) group. During the median 5.2-year follow-up, 11 patients with incident dementia were diagnosed. Patients with severe JVR were significantly more likely to be diagnosed with dementia (log-rank test, p = 0.031). CONCLUSIONS Spontaneous IJV reflux especially severe JVR, was associated with global cognitive function, and potentially with incident dementia.
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Affiliation(s)
- Utako Adachi
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Department of Neurology, Toda General Hospital, Toda, Japan
| | - Sono Toi
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Megumi Hosoya
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Takao Hoshino
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Misa Seki
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Hiroshi Yoshizawa
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | | | - Kenji Maruyama
- Department of Neurology, Toda General Hospital, Toda, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
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4
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Modelling of the dilated sagittal sinuses found in multiple sclerosis suggests increased wall stiffness may be a contributing factor. Sci Rep 2022; 12:17575. [PMID: 36266424 PMCID: PMC9585051 DOI: 10.1038/s41598-022-21810-3] [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: 04/10/2022] [Accepted: 10/04/2022] [Indexed: 01/13/2023] Open
Abstract
The cross-sectional area of the superior sagittal sinus (SSS) is larger in multiple sclerosis than normal and correlates with disease severity and progression. The sinus could be enlarged due to a decrease in the pressure difference between the lumen and the subarachnoid space, an increase in wall thickness or increased wall stiffness. The cross-sectional area of the SSS and straight sinus (ST) were measured in 103 patients with multiple sclerosis and compared to 50 controls. The cross-sectional area of the SSS and ST were increased by 20% and 13% compared to the controls (p = 0.005 and 0.02 respectively). The deflection of the wall of the sinus was estimated. The change in pressure gradient, wall thickness or elastic modulus between groups was calculated by modelling the walls as simply supported beams. To account for these findings, the modelling suggests either a 70% reduction in transmural venous pressure or a 2.4 fold increase in SSS wall stiffness plus an 11% increase in wall thickness or a combination of changes. An increase in sinus pressure, although the most straight forward possibility to account for the change in sinus size may exist in only a minority of patients. An increase in sinus wall stiffness and thickness may need further investigation.
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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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Wu X, Ya J, Zhou D, Ding Y, Ji X, Meng R. Nonthrombotic internal jugular venous stenosis may facilitate cerebral venous thrombosis. CNS Neurosci Ther 2021; 27:1396-1408. [PMID: 34397153 PMCID: PMC8504525 DOI: 10.1111/cns.13719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS To explore the effect of nonthrombotic internal jugular venous stenosis (IJVS) exerted on cerebral venous thrombosis (CVT). METHODS Patients with imaging confirmed CVT were enrolled into this real-world case-control study consecutively from January 2018 through April 2021, and were divided into CVT and IJVS-CVT groups, according to whether or not with non-thrombotic IJVS. Chi-square and logistic regression models were utilized for between-group comparison of thrombotic factors. RESULTS A total of 199 eligible patients entered into final analysis, including 92 cases of CVT and 107 cases of IJVS-CVT. Chi-square revealed that thrombophilic conditions were found in majority of CVT, while only minority in the IJVS-CVT group (83.7% vs. 20.6%, p < 0.001). Multivariate logistic regression indicated that most identified thrombophilia were negatively related to IJVS-CVT (all p < 0.05), including oral contraceptive use (β = -1.38), hyperhomocysteinemia (β = -1.58), hematology (β = -2.05), protein C/S deficiency (β = -2.28), connective tissue disease (β = -1.18) and infection (β = -2.77). All recruited patients underwent standard anticoagulation, 10 cases in IJVS-CVT group also received jugular angioplasty for IJVS correction. Most participants obtained alleviations during 1-year follow-up. However, both clinical and imaging outcomes in IJVS-CVT group were not as good as those in CVT group (both p < 0.05). Moreover, 8 cases with CVT and 7 cases with IJVS-CVT were rehospitalized for CVT recurrences and underwent customized treatment. CONCLUSION Nonthrombotic IJVS may be one of the risk factors of CVT. Anticoagulation might need to be suggested for IJVS patients.
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Affiliation(s)
- Xiaoqin Wu
- 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
| | - Jingyuan 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.,Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - 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
| | - Yuchuan 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
| | - Xunming Ji
- 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
| | - 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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7
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Song SY, Lan D, Wu XQ, Ding YC, Ji XM, Meng R. Clinical characteristics, inflammation and coagulation status in patients with immunological disease-related chronic cerebrospinal venous insufficiency. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:236. [PMID: 33708863 PMCID: PMC7940939 DOI: 10.21037/atm-20-4201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Immunological disease-related chronic cerebrospinal venous insufficiency (CCSVI) is rarely reported. This study aimed to analyze clinical characteristics, inflammation, and coagulation status in patients with immunological disease-related CCSVI. Methods Patients with CCSVI were enrolled from 2017 to 2019 and divided into three cohorts based on their immunological disease backgrounds, including groups with confirmed autoimmune disease, with suspected/subclinical autoimmune disease, and with non-immunological etiology. Immunological, inflammatory, and thrombophilia biomarker assay in blood samples were obtained. Mann-Whitney U test or Fisher’s exact test was used to compare continuous variables or categorical variables between the CCSVI patients with or without the immunological etiology. Spearman’s correlation analysis was conducted among age, baseline neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), interleukin-6 (IL-6), C-reactive protein (CRP), and neuron-specific enolase (NSE) in the three groups. Results A total of 255 consecutive patients with CCSVI were enrolled, including three subgroups: CCSVI with confirmed autoimmune disease (n=41), CCSVI with suspected/subclinical autoimmune disease (n=116) and CCSVI with non-immunological etiology (n=98). In the first subgroup, a series of 41 cases was confirmed with eight different autoimmune diseases including antiphospholipid syndrome (n=18), Sjögren’s syndrome (n=8), immunoglobulin G4-related disease (n=7), Behçet’s disease (n=2), autoimmune hepatitis (n=2), Wegener's granulomatosis (n=2), systemic sclerosis (n=1) and AQP4 antibody-positive neuromyelitis optica spectrum disorder (n=1). Groups with immunological etiology did not show a higher incidence of thrombophilia or increased pro-inflammatory biomarkers (e.g., neutrophil, IL-6). However, patients with non-immunological etiology had a higher baseline level of CRP. Additionally, baseline PLR was moderately correlated to NLR and CRP in CCSVI patients with non-immunological etiology and suspected/subclinical autoimmune disease. Conclusions The formation of CCSVI may be based on the inflammatory process, facilitated by multiple risk factors, among which medical history of immunological diseases may play a significant role due to the intricate relationship between inflammation and coagulation. Moreover, CCSVI may also cause an independent inflammatory injury in venous walls, leading to focal stenosis or thrombus, without attacks from autoimmune antibodies.
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Affiliation(s)
- Si-Ying Song
- 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
| | - Duo Lan
- 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
| | - Xiao-Qin Wu
- 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
| | - Yu-Chuan Ding
- 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, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xun-Ming Ji
- 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
| | - 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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8
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Simka M. An overview of randomized controlled trials on endovascular treatment for chronic cerebrospinal venous insufficiency in multiple sclerosis patients. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1061-3205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractAbout ten years ago it was hoped that venous angioplasty for abnormal veins, primarily the internal jugular veins, will be a much awaited treatment for multiple sclerosis. Yet, a majority of randomized clinical trials on endovascular treatment for chronic cerebrospinal venous insufficiency did not reveal clinical efficacy of these procedures in multiple sclerosis patients. Still, a detailed analysis of these trials suggests that they were poorly designed, underpowered and endovascular techniques used were often far from being optimal. Nonetheless, even considering weak points of these trials, it can be concluded that venous angioplasty should not be used as a routine treatment modality in multiple sclerosis patients. Still, a possibility that some patients may benefit from endovascular treatment cannot be ruled out. This may concern patients at early stage of the disease and presenting with lesions that can easily be managed with balloon angioplasty. Therefore, we need more studies evaluating clinical efficacy of venous angioplasty in selected subgroups of multiple sclerosis patients. Importantly, it has already been demonstrated that venous angioplasty in multiple sclerosis patients is a safe procedure. Thus, also from an ethical point of view, such trials seem justifiable.
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Affiliation(s)
- Marian Simka
- Department of Anatomy, University of Opole, Opole, Poland
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Bai C, Wang Z, Stone C, Zhou D, Ding J, Ding Y, Ji X, Meng R. Pathogenesis and Management in Cerebrovenous Outflow Disorders. Aging Dis 2021; 12:203-222. [PMID: 33532137 PMCID: PMC7801276 DOI: 10.14336/ad.2020.0404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/04/2020] [Indexed: 11/04/2022] Open
Abstract
In keeping with its status as one of the major causes of disability and mortality worldwide, brain damage induced by cerebral arterial disease has been the subject of several decades of scientific investigation, which has resulted in a vastly improved understanding of its pathogenesis. Brain injury mediated by venous etiologies, however, such as cerebral, jugular, and vertebral venous outflow disturbance, have been largely ignored by clinicians. Unfortunately, this inattention is not proportional to the severity of cerebral venous diseases, as the impact they exact on the quality of life of affected patients may be no less than that of arterial diseases. This is evident in disease sequelae such as cerebral venous thrombosis (CVT)-mediated visual impairment, epilepsy, and intracranial hypertension; and the long-term unbearable head noise, tinnitus, headache, dizziness, sleeping disorder, and even severe intracranial hypertension induced by non-thrombotic cerebral venous sinus (CVS) stenosis and/or internal jugular venous (IJV) stenosis. In addition, the vertebral venous system (VVS), a large volume, valveless vascular network that stretches from the brain to the pelvis, provides a conduit for diffuse transmission of tumors, infections, or emboli, with potentially devastating clinical consequences. Moreover, the lack of specific features and focal neurologic signs seen with arterial etiologies render cerebral venous disease prone to both to misdiagnoses and missed diagnoses. It is therefore imperative that awareness be raised, and that as comprehensive an understanding as possible of these issues be cultivated. In this review, we attempt to facilitate these goals by systematically summarizing recent advances in the diagnosis and treatment of these entities, including CVT, CVS stenosis, and IJV stenosis, with the aim of providing a valid, practical reference for clinicians.
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Affiliation(s)
- Chaobo Bai
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongao Wang
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Christopher Stone
- 4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Da Zhou
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiayue Ding
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- 3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xunming Ji
- 2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,5Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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10
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Ding J, Liu Y, Li X, Chen Z, Guan J, Jin K, Wang Z, Ding Y, Ji X, Meng R. Normobaric Oxygen May Ameliorate Cerebral Venous Outflow Disturbance-Related Neurological Symptoms. Front Neurol 2020; 11:599985. [PMID: 33281736 PMCID: PMC7691288 DOI: 10.3389/fneur.2020.599985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/13/2020] [Indexed: 12/23/2022] Open
Abstract
Cerebral venous outflow disturbance (CVOD) has begun to garner the attention of researches owing to a series of clinical symptoms that impose a significant impact on people's quality of life. Herein, we aimed to investigate whether normobaric oxygen (NBO) can ameliorate CVOD-induced neurological symptoms. This was one part of the prospective trial registered in ClinicalTrials.gov (NCT03373292). A total of 37 CVOD patients were divided into the NBO group (5–8 L/min of oxygen inhalation, 1 h per time, 3 times daily, n = 19) and the control group (without oxygen inhalation, n = 18) randomly. The assessments were performed at admission, 1-week hospitalization, and 6-month follow-up. Quantitative electroencephalogram (qEEG) data were recorded prior to and post 1 h of NBO in some patients. R software was used for data analysis. No NBO-related adverse events were observed during the whole NBO intervention process. The 1-week Patient Global Impression of Change (PGIC) scale showed that the symptom improvement occurred in nine patients in the NBO group (47.4%) while none in the control group (p = 0.001). NBO could improve headache evaluated with visual analog scale (pre-NBO vs. post-NBO: 4.70 ± 2.16 vs. 2.90 ± 2.03, p = 0.024) and Headache Impact Test-6 (53.40 ± 12.15 vs. 50.30 ± 13.04, p = 0.041). As for 6-month PGIC follow-up, eight out of 14 cases (57.1%) in the NBO group reported improvement, while only one out of 12 patients in the control group replied mild improvement (p = 0.014). The qEEG revealed that NBO reduced the ratio of theta to alpha power (0.65 ± 0.38 vs. 0.56 ± 0.35, p = 0.030) over the fronto-central electrodes. To sum up, NBO may be a safe and effective approach to attenuate CVOD-related symptoms (especially for headache) by brain functional improvement resulting from increasing oxygen supply to the brain tissues.
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Affiliation(s)
- Jiayue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Liu
- Epilepsy Center, Beijing Fengtai You'anmen Hospital, Beijing, China
| | - Xiangyu Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhiying Chen
- 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
| | - Jingwei Guan
- 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
| | - Kexin Jin
- 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
| | - Zhongao Wang
- 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
| | - Yuchuan 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, United States
| | - Xunming 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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11
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Grazzini I, Calchetti B, Cuneo GL. Developmental venous anomalies in patients with multiple sclerosis: is that a coincidence or an ancillary finding? Neurol Sci 2020; 42:2453-2460. [PMID: 33083936 DOI: 10.1007/s10072-020-04840-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Developmental venous anomalies (DVAs) have been found to be more prevalent in patients with multiple sclerosis (MS). The aim of the study was to compare the prevalence of DVAs in a large population of patients with MS compared with controls and to investigate the correlation of 3D Fluid Attenuated Inversion Recovery (FLAIR) hyperintense signal abnormalities adjacent to DVAs between MS patients and controls having DVAs, as well as DVA potential role in differential diagnosis. METHODS Between January 2001 and December 2019, 349 patients who met the McDonald criteria for MS diagnosis (249 females, 100 males, age range 18-70 years) were retrospectively included in the study. All patients and 340 age-matched healthy controls had brain MRIs performed on a 1.5 Tesla MR system. Two radiologists reviewed all images to identify DVAs; their presence was compared between the MS and control groups. Among the subjects having DVAs, age, gender, adjacent FLAIR anomalies, and DVA location were compared between the two groups. RESULTS Fifty (14.3%) out 349 patients presented 51 DVAs (35 supratentorial and 16 infratentorial), in comparison to 21/340 (6.2%) controls (P = 0.0005). One patient showed 2 simultaneous DVAs, while 3 patients had coexisting pontine capillary telangiectasias. FLAIR white matter changes adjacent to DVAs were found in 46.2% of patients and in 28.1% of controls (P = 0.0001). CONCLUSIONS DVAs demonstrated a higher prevalence in the MS group in comparison to controls. We confirmed the association between DVAs and FLAIR anomalies in MS patients. However, currently there are no evidences that the presence of DVAs may be used in MS differential diagnosis.
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Affiliation(s)
- Irene Grazzini
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy.
| | - Benedetta Calchetti
- Department of Cardiology-Neurology, Section of Neurology, San Donato Hospital, Arezzo, Italy
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12
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Wang Z, Ding J, Bai C, Ding Y, Ji X, Meng R. Clinical Classification and Collateral Circulation in Chronic Cerebrospinal Venous Insufficiency. Front Neurol 2020; 11:913. [PMID: 33071925 PMCID: PMC7538781 DOI: 10.3389/fneur.2020.00913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/16/2020] [Indexed: 12/31/2022] Open
Abstract
Background: As an indispensable part of the cerebral venous system, the extracranial cerebrospinal venous system is not fully recognized. This study aimed to analyze the clinical classification and imaging characteristics of chronic cerebrospinal venous insufficiency (CCSVI) quantitatively. Methods: A total of 128 patients, who were diagnosed as CCSVI by jugular ultrasound and contrast-enhanced magnetic resonance venography (CE-MRV), were enrolled from May 2018 through May 2019. For the patients with possible extraluminal compression, computed tomography venography (CTV) was applied to estimate the degree of internal jugular venous stenosis (IJVS) and rank the vertebral venous collateral circulation. Results: The causes of extraluminal compression induced IJVS included osseous compression (78.95%), carotid artery (24.21%), sternocleidomastoid muscle (5.79%), swollen lymph node (1.05%), and unknown reasons (5.26%). The subtypes of non-compression CCSVI included the high jugular bulb (77.27%), fenestration of the internal jugular vein (IJV) (7.27%), internal jugular phlebectasia (2.73%), tortuous IJV (0.91%), IJV thrombosis (14.55%), and elongated venous valves with/without erythrocyte aggregation (13.64%). For extraluminal compression induced IJVS, the ratio of severe vertebral venous expansion was higher in the severe IJVS group than that in the mild IJVS group (p < 0.001). The IJVS degree was higher in the severe vertebral venous expansion group than in the mild vertebral venous expansion group (p < 0.001). Conclusions: A multimodal diagnostic system is necessary to improve the diagnostic accuracy of CCSVI. The vertebral venous system is an important collateral circulation for CCSVI, which may be a promising indicator for evaluating IJVS degree.
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Affiliation(s)
- Zhongao Wang
- 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
| | - Jiayue 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
| | - Chaobo Bai
- 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
| | - Yuchuan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,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, United States
| | - Xunming 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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Jugular Venous Reflux Can Mimic Posterior Fossa Dural Arteriovenous Fistulas on MRI-MRA. AJR Am J Roentgenol 2020; 216:1626-1633. [PMID: 32876481 DOI: 10.2214/ajr.20.24012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) are high-flow acquired shunts that can carry high risk of intracranial hemorrhage. Because DAVFs can often be managed by endovascular means, early and accurate diagnosis can markedly improve patient morbidity. Time-of-flight and arterial spin-labeling MRA have increased the diagnostic utility of MRI for DAVF by showing hemodynamic rather than anatomic evidence of shunting. The purpose of this article is to describe the cases of seven patients who had co-localization of arterial spin-labeling signal intensity and time-of-flight flow-related enhancement in the left skull base, resulting in a misdiagnosis of DAVF and a recommendation for catheter angiography by the interpreting radiologist. Benign jugular venous reflux is identified as a common mechanism in each case, and the physiology behind this imaging pitfall is described. An algorithmic diagnostic approach to differentiating physiologic venous reflux from true posterior skull base DAVFs is presented.
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14
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Ding J, Guan J, Rajah G, Dornbos D, Li W, Wang Z, Ding Y, Ji X, Meng R. Clinical and neuroimaging correlates among cohorts of cerebral arteriostenosis, venostenosis and arterio-venous stenosis. Aging (Albany NY) 2019; 11:11073-11083. [PMID: 31790365 PMCID: PMC6932895 DOI: 10.18632/aging.102511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022]
Abstract
The purpose of this study was to discriminate the clinical and imaging correlates of cerebral arterial stenosis (CAS), venous stenosis (CVS) and arterio-venous stenosis (CAVS) in the clinical setting. Patients were classified into three groups: CAS (n = 75), CVS (n=74) and CAVS (n=67). Focal neurological deficits were the prominent presenting symptoms in CAS group, while venous turbulence related symptoms were common in both CVS and CAVS group. Risk factor analysis showed the OR (95%CI) for diabetes, male gender and age in CAS vs. CVS group were 13.67(2.71, 68.85), 6.69(2.39, 18.67) and 1.07(1.03, 1.12) respectively. Male gender, diabetes and age in CAVS vs. CAS groups were 0.27(0.11, 0.63), 0.26(0.10, 0.67) and 1.09(1.04, 1.14) respectively, while age in CAVS vs. CVS group was 1.11(1.07, 1.15). The white matter lesions (WMLs) in CAS group varied in size, with clear boundaries asymmetrically distributed in bilateral hemispheres. CVS-induced WMLs revealed a bilaterally symmetric, cloudy-like appearance. The cerebral perfusion was asymmetrically reduced in CAS but symmetrically reduced in CVS group. The clinical characteristics and neuroimaging presentations were different among patients with CAS, CVS and CAVS. We recommended for aged patients, both arterial and venous imaging should be considered in diagnosis of cerebral stenotic vascular disorders.
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Affiliation(s)
- Jiayue 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
| | - Jingwei Guan
- 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
| | - Gary Rajah
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY 14203, USA
| | - David Dornbos
- Department of Neurological Surgery, Semmes-Murphey Clinic and the University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Weili Li
- 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
| | - Zhongao Wang
- 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
| | - Yuchuan 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 48201, USA
| | - Xunming 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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15
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Tucker T. Fluid dynamics of cerebrospinal venous flow in multiple sclerosis. Med Hypotheses 2019; 131:109255. [DOI: 10.1016/j.mehy.2019.109255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/27/2019] [Accepted: 06/01/2019] [Indexed: 02/06/2023]
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16
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Gandhi S, Marr K, Mancini M, Caprio MG, Jakimovski D, Chandra A, Hagemeier J, Hojnacki D, Kolb C, Weinstock-Guttman B, Zivadinov R. No association between variations in extracranial venous anatomy and clinical outcomes in multiple sclerosis patients over 5 years. BMC Neurol 2019; 19:121. [PMID: 31185944 PMCID: PMC6560860 DOI: 10.1186/s12883-019-1350-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/31/2019] [Indexed: 01/08/2023] Open
Abstract
Background No longitudinal, long-term, follow-up studies have explored the association between presence and severity of variations in extracranial venous anatomy, and clinical outcomes in patients with multiple sclerosis (MS). Objective This prospective 5-year follow-up study assessed the relationship of variations in extracranial venous anatomy, indicative of chronic cerebrospinal venous insufficiency (CCSVI) on Doppler sonography, according to the International Society for Neurovascular Disease (ISNVD) proposed consensus criteria, with clinical outcomes and disease progression in MS patients. Methods 90 MS patients (52 relapsing-remitting, RRMS and 38 secondary-progressive, SPMS) and 38 age- and sex-matched HIs were prospectively followed for 5.5 years. Extracranial and transcranial Doppler-based venous hemodynamic assessment was conducted at baseline and follow-up to determine the extent of variations in extracranial venous anatomy. Change in Expanded Disability Status Scale (∆EDSS), development of disability progression (DP) and annualized relapse rate (ARR) were assessed. Results No significant differences were observed in MS patients, based on their presence of variations in extracranial venous anatomy at baseline or at the follow-up, in ∆EDSS, development of DP or ARR. While more MS patients had ISNVD CCSVI criteria fulfilled at baseline compared to HIs (58% vs. 37%, p = 0.03), no differences were found at the 5-year follow-up (61% vs. 56%, p = 0.486). Discussion This is the longest follow-up study assessing the longitudinal relationship between the presence of variations in extracranial venous anatomy and clinical outcomes in MS patients. Conclusion: The presence of variations in extracranial venous anatomy does not influence clinical outcomes over the 5-year follow-up in MS patients. Electronic supplementary material The online version of this article (10.1186/s12883-019-1350-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sirin Gandhi
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Karen Marr
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Marcello Mancini
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Rome, Italy
| | - Maria Grazia Caprio
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Rome, Italy
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Avinash Chandra
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - David Hojnacki
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Channa Kolb
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. .,Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
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17
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Jagannath VA, Pucci E, Asokan GV, Robak EW. Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in people with multiple sclerosis. Cochrane Database Syst Rev 2019; 5:CD009903. [PMID: 31150100 PMCID: PMC6543952 DOI: 10.1002/14651858.cd009903.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a leading cause of neurological disability in young adults. The most widely accepted hypothesis regarding its pathogenesis is that it is an immune-mediated disease. It has been hypothesised that intraluminal defects, compression, or hypoplasia in the internal jugular or azygos veins may be important factors in the pathogenesis of MS. This condition has been named 'chronic cerebrospinal venous insufficiency' (CCSVI). It has been suggested that these intraluminal defects restrict the normal blood flow from the brain and spinal cord, causing the deposition of iron in the brain and the eventual triggering of an auto-immune response. The proposed treatment for CCSVI is venous percutaneous transluminal angioplasty (PTA), which is claimed to improve the blood flow in the brain thereby alleviating some of the symptoms of MS. This is an update of a review first published in 2012. OBJECTIVES To assess the benefit and safety of venous PTA in people with MS and CCSVI. SEARCH METHODS We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group's Specialised Register up to 30 August 2018, CENTRAL (in the Cochrane Library 2018, issue 8), MEDLINE up to 30 August 2018, Embase up to 30 August 2018, metaRegister of Controlled Trials, ClinicalTrials.gov., the Australian New Zealand Clinical Trials Registry, and the World Health Organization (WHO) International Clinical Trials Registry platform. We examined the bibliographies of the included and excluded studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which PTA and sham interventions were compared in adults with MS and CCSVI. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and risk of bias, and extracted data. We reported results as risk ratios (RR) with 95% confidence intervals (CI). We performed statistical analyses using the random-effects model; and we assessed the certainty of the evidence using GRADE. MAIN RESULTS We included three RCTs (238 participants) in this update. One hundred and thirty-four participants were randomised to PTA and 104 to sham treatment. We attributed low risk of bias to two (67%) studies for sequence generation and two (67%) studies for performance bias. All studies were at a low risk of detection bias, attrition bias, reporting bias and other potential sources of bias.There was moderate-quality evidence to suggest that venous PTA did not increase the proportion of patients who had operative or post-operative serious adverse events compared with the sham procedure (RR 3.33, 95% CI 0.36 to 30.44; 3 studies, 238 participants); nor did it increase the proportion of patients who improved on a functional composite measure including walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity over 12-month follow-up (RR 0.84, 95% CI 0.55 to 1.30; 1 study, 110 participants); nor did it reduce the proportion of patients who experienced new relapses at six- or 12-month follow-up (RR 0.87, 95% CI 0.51 to 1.49; 3 studies, 235 participants). There was no effect of venous PTA on disability worsening measured by the Expanded Disability Status Scale, which was reported at follow-up intervals of six months (one study), 11 months (one study) and 12 months (one study). Quality of life was reported in two studies with no difference between treatment groups. Moderate or severe pain during or post venography was reported in both PTA and sham-procedure participants in all included studies. Venous PTA was not effective in restoring blood flow assessed at one-month (one study) or 12-month follow-up (one study). AUTHORS' CONCLUSIONS This systematic review identified moderate-quality evidence that, compared with sham procedure, venous PTA intervention did not provide benefit on patient-centred outcomes (disability, physical or cognitive functions, relapses, quality of life) in people with MS. Venous PTA has proven to be a safe technique but in view of the available evidence of its ineffectiveness, this intervention cannot be recommended in people with MS. All ongoing trials were withdrawn or terminated and hence this updated review is conclusive. No further randomised clinical studies are needed.
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Affiliation(s)
- Vanitha A Jagannath
- American Mission HospitalDepartment of PaediatricsManamaManamaBahrainPO Box 1
| | - Eugenio Pucci
- ASUR Marche ‐ Zona Territoriale 9U.O. Neurologia ‐ Ospedale di MacerataVia Santa Lucia, 3MacerataItaly62100
| | - Govindaraj V Asokan
- University of BahrainCollege of Health SciencesSalmaniya Medical ComplexManamaBahrain
| | - Edward W Robak
- MS ConsumerApt 207, 825 McLeod AveFrederictonNBCanadaE3B 9V4
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18
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Ding JY, Zhou D, Pan LQ, Ya JY, Liu C, Yan F, Fan CQ, Ding YC, Ji XM, Meng R. Cervical spondylotic internal jugular venous compression syndrome. CNS Neurosci Ther 2019; 26:47-54. [PMID: 31119898 PMCID: PMC6930831 DOI: 10.1111/cns.13148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 12/11/2022] Open
Abstract
Aims This study aimed to identify the clinical profiles of cervical spondylosis‐related internal jugular vein stenosis (IJVS) comprehensively. Methods A total of 46 patients, who were diagnosed as IJVS induced by cervical spondylotic compression were recruited. The clinical manifestations and imaging features of IJVS were presented particularly in this study. Results Vascular stenosis was present in 69 out of the 92 internal jugular veins, in which, 50.7% (35/69) of the stenotic vessels were compressed by the transverse process of C1, and 44.9% (31/69) by the transverse process of C1 combined with the styloid process. The transverse process of C1 compression was more common in unilateral IJVS (69.6% vs 41.3%, P = 0.027) while the transverse process of C1 combined with the styloid process compression had a higher propensity to occur in bilateral IJVS (52.2% vs 30.4%, P = 0.087). A representative case underwent the resection of the elongated left lateral mass of C1 and styloid process. His symptoms were ameliorated obviously at 6‐month follow‐up. Conclusions This study proposes cervical spondylotic internal jugular venous compression syndrome as a brand‐new cervical spondylotic subtype. A better understanding of this disease entity can be of great relevance to clinicians in making a proper diagnosis.
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Affiliation(s)
- 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
| | - 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
| | - 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
| | - 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
| | - Cheng Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Yongxin People's Hospital, Ji'an, 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
| | - Chun-Qiu Fan
- Department of China-America Institute of Neuroscience, 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, Michigan
| | - 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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19
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Fulop GA, Tarantini S, Yabluchanskiy A, Molnar A, Prodan CI, Kiss T, Csipo T, Lipecz A, Balasubramanian P, Farkas E, Toth P, Sorond F, Csiszar A, Ungvari Z. Role of age-related alterations of the cerebral venous circulation in the pathogenesis of vascular cognitive impairment. Am J Physiol Heart Circ Physiol 2019; 316:H1124-H1140. [PMID: 30848677 PMCID: PMC6580383 DOI: 10.1152/ajpheart.00776.2018] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 02/07/2023]
Abstract
There has been an increasing appreciation of the role of vascular contributions to cognitive impairment and dementia (VCID) associated with old age. Strong preclinical and translational evidence links age-related dysfunction and structural alterations of the cerebral arteries, arterioles, and capillaries to the pathogenesis of many types of dementia in the elderly, including Alzheimer's disease. The low-pressure, low-velocity, and large-volume venous circulation of the brain also plays critical roles in the maintenance of homeostasis in the central nervous system. Despite its physiological importance, the role of age-related alterations of the brain venous circulation in the pathogenesis of vascular cognitive impairment and dementia is much less understood. This overview discusses the role of cerebral veins in the pathogenesis of VCID. Pathophysiological consequences of age-related dysregulation of the cerebral venous circulation are explored, including blood-brain barrier disruption, neuroinflammation, exacerbation of neurodegeneration, development of cerebral microhemorrhages of venous origin, altered production of cerebrospinal fluid, impaired function of the glymphatics system, dysregulation of cerebral blood flow, and ischemic neuronal dysfunction and damage. Understanding the age-related functional and phenotypic alterations of the cerebral venous circulation is critical for developing new preventive, diagnostic, and therapeutic approaches to preserve brain health in older individuals.
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Affiliation(s)
- Gabor A Fulop
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Heart and Vascular Center, Semmelweis University , Budapest , Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Andrea Molnar
- Heart and Vascular Center, Semmelweis University , Budapest , Hungary
| | - Calin I Prodan
- Veterans Affairs Medical Center , Oklahoma City, Oklahoma
- Department of Neurology, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Tamas Kiss
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
| | - Tamas Csipo
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Agnes Lipecz
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Priya Balasubramanian
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Eszter Farkas
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
| | - Peter Toth
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Cerebrovascular Laboratory, Department of Neurosurgery and Szentagothai Research Center, University of Pecs Medical School , Pecs , Hungary
| | - Farzaneh Sorond
- Department of Neurology, Northwestern University , Chicago, Illinois
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
- Semmelweis University, Department of Pulmonology , Budapest , Hungary
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20
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Hynes SM, Ghahari S, Forwell SJ. "Waiting for Science to Catch up with Practice": an examination of 10-year YouTube trends in discussions of chronic cerebral spinal venous insufficiency treatment for multiple sclerosis. Inform Health Soc Care 2019; 44:327-337. [PMID: 30913949 DOI: 10.1080/17538157.2019.1582052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objective of this longitudinal study examined, first, whether people with multiple sclerosis who previously advocated for angioplasty to treat chronic cerebral spinal venous insufficiency (CCSVI) through YouTube continued reporting benefits. Second, it examined a new cohort reporting on CCSVI treatment, and third, whether perspectives have changed.Method: YouTube videos from August 2011 to January 2019 related to CCSVI were retrieved. Once retrieved, all videos were compiled, classified and analyzed. Categorical data were reported and a pre-determined code-book was used to code videos. Data from the videos were extracted and analyzed using discourse analysis.Results: 1293 videos related to CCSVI were uploaded by 54 people with multiple sclerosis who met the inclusion criteria. YouTube videos uploaded by people with multiple sclerosis have shifted in volume and message. The initial surge in interest in CCSVI treatment has diminished, but there still exists strong advocates for its use. There appears to be an inconsistency between positive results, actual improvements in symptoms, and the overall messages reported. Very little long-term data was available as the procedure is relatively new.Conclusion: Practitioners may be faced with pressure to provide unproven treatments in the future and should be understanding but evidence-driven when supporting multiple sclerosis therapies.
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Affiliation(s)
- Sinéad M Hynes
- Discipline of Occupational Therapy, College of Medicine, Nursing and Health Sciences, Áras Moyola, National University of Ireland, Galway, Ireland
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.,Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Susan J Forwell
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
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Han K, Hu HH, Chao AC, Chang FC, Chung CP, Hsu HY, Sheng WY, Wu J. Transient Global Amnesia Linked to Impairment of Brain Venous Drainage: An Ultrasound Investigation. Front Neurol 2019; 10:67. [PMID: 30804883 PMCID: PMC6370701 DOI: 10.3389/fneur.2019.00067] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 01/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Previous neuroimaging and ultrasound studies suggested that compression and stenosis of the internal jugular vein (IJV) in patients with transient global amnesia (TGA) may impair IJV drainage, while a patent IJV releases intracranial pressure caused by the Valsalva maneuver (VM). Methods: Seventy-nine TGA patients with complete ultrasound examination data during admission were recruited prospectively to evaluate IJV drainage, which included the time-averaged mean velocity, and the cross-sectional lumen area of the IJV at the vein's middle (J2) and distal (J3) segments and the cross-sectional area during a 10-s VM to test for any retrograde or anti-grade flow. Forty-five TGA patients and 45 age- and sex-matched control subjects underwent complete contrast-enhanced magnetic resonance (MR) venous studies, which included time-resolved imaging of contrast kinetics, contrast-enhanced axial T1-weighted MR imaging, and phase-contrast-based non-contrast enhanced magnetic resonance venography (MRV). Results: In those subjects with complete MRV studies, the flow volumes exhibited at both the J2 and J3 segments of the left IJV and left vertebral vein (VV) were significantly lower in the TGA patients than in the control subjects. Although there was no significant difference in the flow volume of right IJV, the total of bilateral IJV, and VV flow volumes was still significantly lower in the TGA patients. As compared with the control subjects, the TGA patients exhibited significantly higher prevalence of completely blocked right IJV drainage at the J3 segment during the VM, but non-significantly higher for the left IJV at the J3 segment and for the right IJV at the J2 segment. Conclusion: Our results confirmed that the total venous flow decreases in the IJVs and VVs of the patients with TGA. This is consistent with the findings of previous MR imaging studies that have reported about compression and stenosis of the draining veins. We also found that IJV drainage is relatively compromised during the VM in the patients with TGA.
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Affiliation(s)
- Ke Han
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Han-Hwa Hu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cerebrovascular Treatment and Research Center, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Taipei Medical University-Shaung Ho Hospital, Taipei, Taiwan
| | - A-Ching Chao
- Department of Neurology, College of Medicine, Kaohsiung Medical University and Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Chih-Ping Chung
- Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Hung-Yi Hsu
- Department of Neurology, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan
| | - Wen-Yung Sheng
- Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Jiang Wu
- Department of Neurology, First Hospital of Jilin University, Changchun, China
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22
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Paul F, Wattjes MP. Venoplasty in MS: Therapeutic intervention without any evidence. Neurology 2018; 91:815-816. [PMID: 30266888 DOI: 10.1212/wnl.0000000000006419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Friedemann Paul
- Charité-Universitätsmedizin Berlin (F.P.), Freie Universität Berlin and Humboldt-Universität zu Berlin and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin; Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine, Charité-Universitätsmedizin Berlin; and Department of Neuroradiology (M.P.W.), Hannover Medical School, Germany.
| | - Mike P Wattjes
- Charité-Universitätsmedizin Berlin (F.P.), Freie Universität Berlin and Humboldt-Universität zu Berlin and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin; Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine, Charité-Universitätsmedizin Berlin; and Department of Neuroradiology (M.P.W.), Hannover Medical School, Germany
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23
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Rogers DM, Shah LM, Wiggins RH. The Central Vein: FLAIR Signal Abnormalities Associated with Developmental Venous Anomalies in Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2018; 39:2007-2013. [PMID: 30337437 DOI: 10.3174/ajnr.a5819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/09/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Demyelination is a recently recognized cause of FLAIR hyperintensities associated with developmental venous anomalies. Our purpose was to quantify the prevalence of white matter signal abnormalities associated with developmental venous anomalies in patients with multiple sclerosis compared with controls. MATERIALS AND METHODS A retrospective, blinded, multireader study compared the prevalence of FLAIR hyperintense signal abnormalities adjacent to developmental venous anomalies in patients with MS compared with controls (patients with developmental venous anomalies without MS). Study findings were positive if a central vein was demonstrated using FLAIR and contrast-enhanced fat-saturated T1 sequences. Imaging parameters also included developmental venous anomaly location, developmental venous anomaly drainage, white matter lesion size, and depth of white matter lesions. Clinical parameters included age, sex, and the presence of confounding variables (hypertension, diabetes, migraines, and/or vasculopathy). RESULTS FLAIR signal abnormality was present around 47.3% (35/74) of developmental venous anomalies in patients with MS, and 13.5% (10/74) of developmental venous anomalies in the control group (P < .001). The multivariate logistic regression model controlling for covariates (including migraines, hypertension, diabetes mellitus, vasculopathy, age, sex, and drainage direction of developmental venous anomalies) showed that the odds of FLAIR hyperintensity around developmental venous anomalies was 6.7-fold higher in patients with MS (relative risk MS = 6.68; 95% CI, 2.79-15.97; P < .001). CONCLUSIONS The association of developmental venous anomalies and FLAIR hyperintensities was more common in patients with MS, which suggests that the underlying demyelinating pathologic process of MS may be the cause of this propensity in patients with MS. Impaired venous drainage in the territory of developmental venous anomalies may predispose to development of these lesions, and an associated central vein is helpful in understanding an atypical location of MS plaques.
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Affiliation(s)
- D M Rogers
- From the Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah.
| | - L M Shah
- From the Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - R H Wiggins
- From the Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah
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24
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Traboulsee AL, Machan L, Girard JM, Raymond J, Vosoughi R, Hardy BW, Emond F, Gariepy JL, Bone JN, Siskin G, Klass D, Isserow S, Illes J, Sadovnick AD, Li DK. Safety and efficacy of venoplasty in MS: A randomized, double-blind, sham-controlled phase II trial. Neurology 2018; 91:e1660-e1668. [PMID: 30266886 PMCID: PMC6207414 DOI: 10.1212/wnl.0000000000006423] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 07/19/2018] [Indexed: 01/09/2023] Open
Abstract
Objective To determine the safety and efficacy of balloon vs sham venoplasty of narrowing of the extracranial jugular and azygos veins in multiple sclerosis (MS). Methods Patients with relapsing or progressive MS were screened using clinical and ultrasound criteria. After confirmation of >50% narrowing by venography, participants were randomized 1:1 to receive balloon or sham venoplasty of all stenoses and were followed for 48 weeks. Participants and research staff were blinded to intervention allocation. The primary safety outcome was the number of adverse events (AEs) during 48 weeks. The primary efficacy outcome was the change from baseline to week 48 in the patient-reported outcome MS Quality of Life–54 (MSQOL-54) questionnaire. Standardized clinical and MRI outcomes were also evaluated. Results One hundred four participants were randomized (55 sham; 49 venoplasty) and 103 completed 48 weeks of follow-up. Twenty-three sham and 21 venoplasty participants reported at least 1 AE; one sham (2%) and 5 (10%) venoplasty participants had a serious AE. The mean improvement in MSQOL-54 physical score was +1.3 (sham) and +1.4 (venoplasty) (p = 0.95); MSQOL-54 mental score was +1.2 (sham) and −0.8 (venoplasty) (p = 0.55). Conclusions Our data do not support the continued use of venoplasty of extracranial jugular and/or azygous venous narrowing to improve patient-reported outcomes, chronic MS symptoms, or the disease course of MS. ClinicalTrials.gov identifier NCT01864941. Classification of evidence This study provides Class I evidence that for patients with MS, balloon venoplasty of extracranial jugular and azygous veins is not beneficial in improving patient-reported, standardized clinical, or MRI outcomes.
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Affiliation(s)
- Anthony L Traboulsee
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY.
| | - Lindsay Machan
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - J Marc Girard
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Jean Raymond
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Reza Vosoughi
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Brian W Hardy
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Francois Emond
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Jean-Luc Gariepy
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Jeffrey N Bone
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Gary Siskin
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Darren Klass
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Saul Isserow
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - Judy Illes
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - A Dessa Sadovnick
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
| | - David K Li
- From the University of British Columbia, Departments of Medicine (Neurology) (A.L.T., S.I., J.I., A.D.S.), Radiology (L.M., D.K., D.K.L.), Medical Genetics (A.D.S.), and Statistics (J.N.B.), Vancouver; Centre Hospitalier de l'Université de Montréal (J.M.G., J.R.), Hôpital Notre-Dame, Montreal; Health Sciences Centre (R.V., B.W.H.), Winnipeg; Centre Hospitalier Universitaire de Québec-Université Laval (F.E., J.-L.G.), Hôpital Enfant-Jésus, Quebec, Canada; and Albany Medical Center (G.S.), NY
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Benjaminy S, Schepmyer A, Illes J, Traboulsee A. Resilience, trust, and civic engagement in the post-CCSVI era. BMC Health Serv Res 2018; 18:366. [PMID: 29769084 PMCID: PMC5956844 DOI: 10.1186/s12913-018-3130-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 04/16/2018] [Indexed: 12/27/2022] Open
Abstract
Background Scientific and financial investments in chronic cerebrospinal venous insufficiency (CCSVI) research have been made to address both the hope for and scepticism over this interventional strategy for MS. Despite limited evidence in support of the CCSVI hypothesis, the funding of clinical research was responsive to a demand by the public rarely seen in the history of medicine. We characterize patient perspectives about the CCSVI research trajectory, with particular attention to its impact on other non-pharmaceutical areas of MS research with a focus on stem cell interventions. Methods Semi-structured interviews with 20 MS patients across Canada who did not have CCSVI interventions. Interviews were analysed for recurring themes and individual variations using the constant comparative approach. Results Participants had a critical view of the divestment of funds from longstanding research to support CCSVI trials. They retain a sense of optimism, however, about emerging evidence for stem cell interventions for MS, and highlight the need for greater caution and conscientious communication of advances in medicine and science. Conclusions The unrealized hopes for CCSVI challenged but did not undermine the resilience of patient communities. The narrative that unfolded highlights the importance of drawing a socially-minded space for public participation in science.
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Affiliation(s)
- Shelly Benjaminy
- Neuroethics Canada, University of British Columbia, Vancouver, Canada.,Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Illinois, Canada.,Current: Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Andrew Schepmyer
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Illinois, Canada
| | - Judy Illes
- Neuroethics Canada, University of British Columbia, Vancouver, Canada.
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Illinois, Canada.
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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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27
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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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29
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From embodied risk to embodying hope: Therapeutic experimentation and experiential information sharing in a contested intervention for Multiple Sclerosis. BIOSOCIETIES 2017. [DOI: 10.1057/s41292-017-0066-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sethi SK, Daugherty AM, Gadda G, Utriainen DT, Jiang J, Raz N, Haacke EM. Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow. AJNR Am J Neuroradiol 2017; 38:1617-1622. [PMID: 28546249 DOI: 10.3174/ajnr.a5219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/13/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE To date, research on extracranial venous collaterals has been focused on structure, with relatively little attention paid to hemodynamics. We addressed this limitation by quantitatively comparing collateral flow in patients with multiple sclerosis and healthy controls by using phase-contrast MR imaging. We hypothesize that patients with MS with structurally anomalous internal jugular veins will have elevated collateral venous flow compared with healthy controls. MATERIALS AND METHODS The sample consisted of 276 patients with MS and 106 healthy controls. We used MRV to classify internal jugular veins as stenotic and nonstenotic based on an absolute cross-sectional area threshold in 276 patients with MS and 60 healthy controls; 46 healthy controls lacked this imaging. Individual and total vessel flows were quantified by using phase-contrast MR imaging on all patients. Veins were classified by extracranial drainage type: internal jugular veins (I), paraspinal (II), and superficial (III). Differences among healthy controls, patients with MS, nonstenotic patients, and stenotic subgroups in total venous flow by vessel type were evaluated in a general linear model for statistical analysis. RESULTS In the MS group, 153 patients (55%) evidenced stenosis, whereas 12 (20%) healthy controls were classified as stenotic (P < .001). Compared with healthy controls, the MS group showed lower type I flow and increased type II flow. Stenosis was associated with reduced flow in the type I vessels [F(1272) = 68; P < .001]. The stenotic MS group had increased flow in the type II vessels compared with the nonstenotic MS group [F(1272) = 67; P < .001]. CONCLUSIONS Compared with healthy controls, patients with MS exhibit reduced venous flow in the main extracerebral drainage vein (internal jugular vein). In contrast, flow in the paraspinal venous collaterals is elevated in patients with MS and exacerbated by venous stenosis. Collateral drainage may be a compensatory response to internal jugular vein flow reduction.
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Affiliation(s)
- S K Sethi
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
| | | | - G Gadda
- Department of Physics and Earth Sciences (G.G.), University of Ferrara, Ferrara, Italy
| | - D T Utriainen
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
| | - J Jiang
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
| | - N Raz
- Institute of Gerontology (A.M.D., N.R.)
- Departments of Psychology (N.R.)
| | - E M Haacke
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
- Radiology (E.M.H.), Wayne State University, Detroit, Michigan
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Laukontaus SJ, Pekkola J, Numminen J, Kagayama T, Lepäntalo M, Färkkilä M, Atula S, Tienari P, Venermo M. Magnetic Resonance Imaging of Internal Jugular Veins in Multiple Sclerosis: Interobserver Agreement and Comparison with Doppler Ultrasound Examination. Ann Vasc Surg 2017; 42:84-92. [DOI: 10.1016/j.avsg.2016.10.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/15/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022]
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Schrauben EM, Kohn S, Macdonald J, Johnson KM, Kliewer M, Frost S, Fleming JO, Wieben O, Field A. Four-dimensional flow magnetic resonance imaging and ultrasound assessment of cerebrospinal venous flow in multiple sclerosis patients and controls. J Cereb Blood Flow Metab 2017; 37:1483-1493. [PMID: 27364001 PMCID: PMC5453467 DOI: 10.1177/0271678x16657345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A possibly causal relationship between multiple sclerosis and chronic cerebrospinal venous insufficiency has recently been hypothesized. Studies investigating chronic cerebrospinal venous insufficiency have reported conflicting results and few have employed multiple diagnostic imaging modalities across a large patient and control population. In this study, three complementary imaging modalities were used to investigate the chronic cerebrospinal venous insufficiency hypothesis in patients with multiple sclerosis and two age- and sex-matched control groups: healthy volunteers and patients with other neurological diseases. Strictly blinded Doppler ultrasound according to the original chronic cerebrospinal venous insufficiency hypothesis; four-dimensional flow magnetic resonance imaging of venous flow in the head, neck, and chest; and contrast-enhanced magnetic resonance venography for neck and chest venous luminography were acquired. An internal jugular vein stenosis evaluation was also performed across modalities. Percentage of subjects meeting ultrasound-based chronic cerebrospinal venous insufficiency criteria was small and similar between groups. In group-wise and pairwise testing, no four-dimensional flow magnetic resonance imaging variables were statistically significantly different, for any measurement location. In contrast-enhanced magnetic resonance venography of the internal jugular and azygos veins, no statistically significant differences were observed in stenosis scores between groups. These results represent compelling evidence against the chronic cerebrospinal venous insufficiency hypothesis in multiple sclerosis.
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Affiliation(s)
- Eric M Schrauben
- 1 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sarah Kohn
- 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Jacob Macdonald
- 3 Department of Medical Physics, University of Wisconsin-Madison, Madison, USA
| | - Kevin M Johnson
- 3 Department of Medical Physics, University of Wisconsin-Madison, Madison, USA
| | - Mark Kliewer
- 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Sam Frost
- 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - John O Fleming
- 4 Department of Neurology, University of Wisconsin-Madison, Madison, USA
| | - Oliver Wieben
- 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA.,3 Department of Medical Physics, University of Wisconsin-Madison, Madison, USA
| | - Aaron Field
- 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA.,5 Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, USA
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Martin N, Traboulsee AL, Machan L, Klass D, Ellchuk T, Zhao Y, Knox KB, Kopriva D, Lala S, Nickel D, Otani R, Perera WR, Rauscher A, Sadovnick AD, Szkup P, Li DK. Prevalence of Extracranial Venous Narrowing on Magnetic Resonance Venography Is Similar in People With Multiple Sclerosis, Their Siblings, and Unrelated Healthy Controls: A Blinded, Case-Control Study. Can Assoc Radiol J 2016; 68:202-209. [PMID: 27887935 DOI: 10.1016/j.carj.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/09/2016] [Accepted: 07/06/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The study sought to assess and compare the prevalence of narrowing of the major extracranial veins in subjects with multiple sclerosis and controls, and to assess the sensitivity and specificity of magnetic resonance venography (MRV) for describing extracranial venous narrowing as it applies to the chronic cerebrospinal venous insufficiency theory, using catheter venography (CV) as the gold standard. METHODS The jugular and azygos veins were assessed with time-of-flight MRV in this assessor-blinded, case-control study of subjects with multiple sclerosis, their unaffected siblings, and unrelated controls. The veins were evaluated by diameter and area, and compared with CV. Collateral vessels were also analyzed for maximal diameter, as a potential indicator of compensatory flow. RESULTS A high prevalence of extracranial venous narrowing was demonstrated in all study groups, collectively up to 84% by diameter criteria and 90% by area, with no significant difference between the groups when assessed independently (P = .34 and .63, respectively). There was high interobserver variability in the reporting of vessel narrowing (kappa = 0.32), and poor vessel per vessel correlation between narrowing on MRV and CV (kappa = 0.064). Collateral neck veins demonstrated no convincing difference in maximum size or correlation with jugular narrowing. CONCLUSION There is a high prevalence of narrowing of the major extracranial veins on MRV in all 3 study groups, with no significant difference between them. These findings do not support the chronic cerebrospinal venous insufficiency theory. Although MRV has shown a high sensitivity for identifying venous narrowing, time-of-flight imaging demonstrates poor interobserver agreement and poor specificity when compared with the gold standard CV.
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Affiliation(s)
- Nancy Martin
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Anthony L Traboulsee
- Department of Medicine (Neurology), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Machan
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Klass
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tasha Ellchuk
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yinshan Zhao
- Department of Medicine (Neurology), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine B Knox
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David Kopriva
- Department of Surgery, College of Medicine, University of Saskatchewan and Regina Qu'Appelle Health Region (Section of Vascular Surgery), Regina, Saskatchewan, Canada
| | - Shantilal Lala
- Department of Medical Imaging, College of Medicine, University of Saskatchewan and Regina Qu-Appelle Health Region, Regina, Saskatchewan, Canada
| | - Darren Nickel
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert Otani
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Warren R Perera
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Dessa Sadovnick
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Szkup
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David K Li
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Sisini F, Tessari M, Menegatti E, Vannini ME, Gianesini S, Tavoni V, Gadda G, Gambaccini M, Taibi A, Zamboni P. Clinical Applicability of Assessment of Jugular Flow over the Individual Cardiac Cycle Compared with Current Ultrasound Methodology. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1750-1763. [PMID: 27108038 DOI: 10.1016/j.ultrasmedbio.2016.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
There is growing interest in measuring cerebral venous outflow with ultrasound (US). However, results obtained with the current US Doppler methodology, which uses just a single value of cross-sectional area (CSA) of the vessel, are highly variable and inconclusive. The product of CSA and time-averaged velocity in the case of pulsatile vessels may be a possible source of error, particularly for a pulsatile vein like the internal jugular vein (IJV), where the cardiac pump transmits a sequence of well-established waves along the conduit. We herein propose a novel technique for US IJV flow assessment that accurately accounts for IJV CSA variations during the cardiac cycle. Five subjects were investigated with a high-resolution real-time B-mode video, synchronized with an electrocardiography trace. In this approach, CSA variations representing the pulsatility of the IJV are overlapped with the velocity curve obtained by the usual spectral Doppler trace. The overlap is then phased point by point using the electrocardiography pacemaker. This allows us to experimentally measure the velocity variation in relation to the change in CSA precisely, ultimately enabling calculation of IJV flow. (i) The sequence of CSA variation with respect to the electrocardiography waves corresponds exactly to the jugular venous pulse as measured in physiology. (ii) The methodology permits us to phase the velocity and CSA, which is ultimately what is currently lacking to precisely calculate the flow in the IJV with US. (iii) The time-averaged flow, calculated with the described technique, is very close to that calculated assuming a constant IJV CSA, whereas the time-dependent flow shows differs as much as 40%. (iv) Finally, we tested the accuracy of the technique with a methodology that may allow for universal assessment of the accuracy of each personal US-based evaluation of flow rate.
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Affiliation(s)
- Francesco Sisini
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy; Vascular Diseases Center, University of Ferrara, Cona (FE), Italy.
| | - Mirko Tessari
- Vascular Diseases Center, University of Ferrara, Cona (FE), Italy
| | - Erica Menegatti
- Vascular Diseases Center, University of Ferrara, Cona (FE), Italy
| | | | - Sergio Gianesini
- Vascular Diseases Center, University of Ferrara, Cona (FE), Italy
| | - Valentina Tavoni
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Giacomo Gadda
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Mauro Gambaccini
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Angelo Taibi
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Cona (FE), Italy
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Cocozza S, Canna A, Lanzillo R, Russo C, Postiglione E, Liuzzi R, Vastola M, Brunetti A, Salvatore M, Brescia Morra V, Palma G, Tedeschi E. Lack of correlation between extracranial venous abnormalities and multiple sclerosis: a quantitative MRI study. Br J Radiol 2016; 89:20160321. [PMID: 27282838 DOI: 10.1259/bjr.20160321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: We aimed to evaluate the presence of venous stenosis and blood flow abnormalities in the neck vessels of patients with multiple sclerosis (MS), in respect to a group of age- and sex-matched healthy controls (HC), and their possible relations with clinical variables using a semi-automated quantitative MRI method. METHODS: 45 patients with relapsing remitting MS and 40 HC were enrolled in this study. Flow rates and cross-sectional areas of arterial and venous neck vessels were assessed by phase-contrast MRI at two different neck levels (C2-C3 and C6-C7), and differences between groups were evaluated with an unpaired t-test. Correlation between blood flow variables and clinical parameters was analyzed with Spearman's test. RESULTS: A significant internal jugular vein (IJV) stenosis was found in 23/45 (51.1%) patients with MS and 18/40 (45.0%) HC. No differences were observed between patients with MS and HC for any of the flow measures obtained. No correlations were found between MRI measures and any of the tested clinical variables. CONCLUSION: No differences in the IJV area emerged at quantitative MRI evaluation, suggesting that stenosis of the extracranial veins is unrelated to MS. Furthermore, no flow differences in the neck vessels were found between patients with MS and HC in any of the tested flow measures, with no correlation with clinical variables. Our results confirm that the hypothesis of the presence of extracranial venous abnormalities in MS, both in terms of stenosis or flow measures, is not suitable. ADVANCES IN KNOWLEDGE: Neck venous drainage abnormalities have been claimed to be associated with MS. Conversely, our quantitative MRI analysis seems to exclude that extracranial venous alterations are related to the disease.
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Affiliation(s)
- Sirio Cocozza
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonietta Canna
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Roberta Lanzillo
- 2 Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Carmela Russo
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuela Postiglione
- 2 Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Liuzzi
- 3 Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Michele Vastola
- 3 Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Arturo Brunetti
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Vincenzo Brescia Morra
- 2 Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Palma
- 3 Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Enrico Tedeschi
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Ghahari S, Forwell SJ. Social Media Representation of Chronic Cerebrospinal Venous Insufficiency Intervention for Multiple Sclerosis. Int J MS Care 2016; 18:49-57. [PMID: 27134577 DOI: 10.7224/1537-2073.2014-073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND We conducted a rigorous review of videos related to multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI) treatment posted by people with MS on one social media website (YouTube) that describe symptoms before and after the surgical procedure, as well as videos presented by health-care professionals (HCPs). METHODS All relevant videos posted from December 2009 to July 2011 were downloaded, viewed, and systematically organized. Categorical data were classified, and dominant messages were gleaned. RESULTS A total of 1789 videos were extracted. A total of 621 videos by people with MS and 238 by HCPs were included. Eighty-six percent of people with MS anecdotally reported experiencing some improvement in at least one symptom. The most common message was that "CCSVI is not a miracle but worth trying." Most HCPs posting videos recommended the procedure but called for continued research. CONCLUSIONS Social media are conveying an anecdotal favorable message about CCSVI treatment for MS. The relative absence of videos offering a negative or more balanced perspective is a concern. Social persuasion through these videos creates a strong positive impression of CCSVI treatment, but the videos do not acknowledge the lack of supporting scientific evidence and the possible role of the placebo effect. Given the strong influence of social media on health-care decision making, researchers and clinicians should actively use social media to reach out to people with MS and describe the state of the evidence for MS treatments, both positive and negative.
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Affiliation(s)
- Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada (SG); Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran (SG); and Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada (SJF)
| | - Susan J Forwell
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada (SG); Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran (SG); and Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada (SJF)
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Petolicchio B, Viganò A, di Biase L, Tatulli D, Toscano M, Vicenzini E, Passarelli F, Di Piero V. Cerebral venous hemodynamic abnormalities in episodic and chronic migraine. FUNCTIONAL NEUROLOGY 2016; 31:81-6. [PMID: 27358220 DOI: 10.11138/fneur/2016.31.2.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Alterations of cerebral venous drainage have been demonstrated in chronic migraine (CM), suggesting that cerebral venous hemodynamic abnormalities (CVHAs) play a role in this condition. The aim of the present study was to look for a correlation between CM and CVHAs. We recruited 33 subjects suffering from CM with or without analgesic overuse, 29 episodic migraine (EM) patients with or without aura, and 21 healthy subjects as controls (HCs). CVHAs were evaluated by transcranial and extracranial echo-color Doppler evaluation of five venous hemodynamic parameters. CVHAs were significantly more frequent in the CM and EM patients than in the HCs. In the migraine patients, CVHAs were not correlated with clinical features. The significantly greater frequency of CVHAs observed in the migraineurs may reflect a possible relationship between migraine and these abnormalities. Prospective longitudinal studies are needed to investigate whether CVHAs have a role in the processes of migraine chronification.
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Why Current Doppler Ultrasound Methodology Is Inaccurate in Assessing Cerebral Venous Return: The Alternative of the Ultrasonic Jugular Venous Pulse. Behav Neurol 2016; 2016:7082856. [PMID: 27006525 PMCID: PMC4783538 DOI: 10.1155/2016/7082856] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/24/2015] [Accepted: 02/01/2016] [Indexed: 12/28/2022] Open
Abstract
Assessment of cerebral venous return is growing interest for potential application in clinical practice. Doppler ultrasound (DUS) was used as a screening tool. However, three meta-analyses of qualitative DUS protocol demonstrate a big heterogeneity among studies. In an attempt to improve accuracy, several authors alternatively measured the flow rate, based on the product of the time average velocity with the cross-sectional area (CSA). However, also the quantification protocols lacked of the necessary accuracy. The reasons are as follows: (a) automatic measurement of the CSA assimilates the jugular to a circle, while it is elliptical; (b) the use of just a single CSA value in a pulsatile vessel is inaccurate; (c) time average velocity assessment can be applied only in laminar flow. Finally, the tutorial describes alternative ultrasound calculation of flow based on the Womersley method, which takes into account the variation of the jugular CSA overtime. In the near future, it will be possible to synchronize the electrocardiogram with the brain inflow (carotid distension wave) and with the outflow (jugular venous pulse) in order to nicely have a noninvasive ultrasound picture of the brain-heart axis. US jugular venous pulse may have potential use in neurovascular, neurocognitive, neurosensorial, and neurodegenerative disorders.
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Magnano C, Belov P, Krawiecki J, Hagemeier J, Beggs C, Zivadinov R. Internal Jugular Vein Cross-Sectional Area Enlargement Is Associated with Aging in Healthy Individuals. PLoS One 2016; 11:e0149532. [PMID: 26895434 PMCID: PMC4760933 DOI: 10.1371/journal.pone.0149532] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/02/2016] [Indexed: 01/09/2023] Open
Abstract
Background Internal jugular vein (IJV) narrowing has been implicated in central nervous system pathologies, however normal physiological age- and gender-related IJV variance in healthy individuals (HIs) has not been adequately assessed. Objectives We assessed the relationship between IJV cross-sectional area (CSA) and aging. Materials and Methods This study involved 193 HIs (63 males and 130 females) who received 2-dimensional magnetic resonance venography at 3T. The minimum CSA of the IJVs at cervical levels C2/C3, C4, C5/C6, and C7/T1 was obtained using a semi-automated contouring-thresholding technique. Subjects were grouped by decade. Pearson and partial correlation (controlled for cardiovascular risk factors, including hypertension, heart disease, smoking and body mass index) and analysis of variance analyses were used, with paired t-tests comparing side differences. Results Mean right IJV CSA ranges were: in males, 41.6 mm2 (C2/C3) to 82.0 mm2 (C7/T1); in females, 38.0 mm2 (C2/C3) to 62.3 mm2 (C7/T1), while the equivalent left side ranges were: in males, 28.0 mm2 (C2/C3) to 52.2 mm2 (C7/T1); in females, 27.2 mm2 (C2/C3) to 47.8 mm2 (C7/T1). The CSA of the right IJVs was significantly larger (p<0.001) than the left at all cervical levels. Controlling for cardiovascular risk factors, the correlation between age and IJV CSA was more robust in males than in the females for all cervical levels. Conclusions In HIs age, gender, hand side and cervical location all affect IJV CSA. These findings suggest that any definition of IJV stenosis needs to account for these factors.
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Affiliation(s)
- Christopher Magnano
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
- MRI Clinical and Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Pavel Belov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Jacqueline Krawiecki
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Clive Beggs
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
- Centre for Infection Control and Biophysics, University of Bradford, Richmond Road, Bradford BD7 1DP, United Kingdom
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, LS1 3HE, United Kingdom
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
- MRI Clinical and Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
- * E-mail:
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40
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Rasman A. Chronic Cerebrospinal Venous Insufficiency. Vasc Specialist Int 2015; 31:106-7. [PMID: 26509142 PMCID: PMC4603685 DOI: 10.5758/vsi.2015.31.3.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/14/2015] [Indexed: 11/21/2022] Open
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Kugler N, Patel PJ, Lee CJ. Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis: A Failed Concept. Vasc Specialist Int 2015. [PMID: 26217638 PMCID: PMC4480289 DOI: 10.5758/vsi.2015.31.1.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In 2009 Paolo Zamboni et al. implicated that chronic cerebral venous congestion lead to the development of multiple sclerosis. In this review, we examined the role of chronic cerbrospinal venous insufficiency in multiple sclerosis and the proposed therapy entailing venous angioplasty and stenting of extracranial veins with available evidence to date.
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Affiliation(s)
- Nathan Kugler
- Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Parag J Patel
- Division of Interventional Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cheong Jun Lee
- Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI
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42
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No Association of Chronic Cerebrospinal Venous Insufficiency with Multiple Sclerosis. Can J Neurol Sci 2015; 43:195-7. [PMID: 26194114 DOI: 10.1017/cjn.2015.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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43
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Sethi SK, Utriainen DT, Daugherty AM, Feng W, Hewett JJ, Raz N, Haacke EM. Jugular Venous Flow Abnormalities in Multiple Sclerosis Patients Compared to Normal Controls. J Neuroimaging 2015; 25:600-7. [PMID: 25316522 PMCID: PMC4398578 DOI: 10.1111/jon.12183] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/13/2014] [Accepted: 09/13/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To determine if extracranial venous structural and flow abnormalities exist in patients with multiple sclerosis (MS). METHODS Magnetic resonance imaging was used to assess the anatomy and function of major veins in the neck in 138 MS patients and 67 healthy controls (HC). Time-of-flight MR angiography (MRA) was used to assess stenosis while 2-dimensional phase-contrast flow quantification was used to assess flow at the C2/C3 and C5/C6 levels. Venous flow was normalized to the total arterial flow. The MS patients were divided into stenotic (ST) and nonstenotic (NST) groups based on MRA assessment, and each group was compared to the HC group in anatomy and flow. RESULTS The MS group showed lower normalized internal jugular vein (IJV) blood flow (tIJV/tA) than the HC group (P < .001). In the MS group, 72 (52%) were classified as ST while 66 (48%) were NST. In the HC group, 11 (23%) were ST while 37 (77%) were NST. The ST-MS group had lower IJV flow than both HC and NST-MS groups. CONCLUSION After categorizing the MS population into two groups based upon anatomical stenosis, as determined from an absolute quantification of IJV cross section, clear differences in IJV flow between the ST-MS and HC samples became evident. Despite the unknown etiology of MS, abnormal venous flow was noted in a distinct group of MS patients compared to HC.
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Affiliation(s)
- Sean K Sethi
- MRI Institute of Biomedical Research, Detroit, Michigan
| | | | - Ana M Daugherty
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan
| | - Wei Feng
- Department of Radiology, Wayne State University, Detroit, Michigan
| | | | - Naftali Raz
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan
| | - E Mark Haacke
- MRI Institute of Biomedical Research, Detroit, Michigan
- Department of Radiology, Wayne State University, Detroit, Michigan
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44
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Ploughman M, Manning OJ, Beaulieu S, Harris C, Hogan SH, Mayo N, Fisk JD, Sadovnick AD, O'Connor P, Morrow SA, Metz LM, Smyth P, Allderdice PW, Scott S, Marrie RA, Stefanelli M, Godwin M. Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case-control study. BMC Health Serv Res 2015; 15:161. [PMID: 25881078 PMCID: PMC4424567 DOI: 10.1186/s12913-015-0835-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/06/2015] [Indexed: 11/17/2022] Open
Abstract
Background Following the initial reports of Chronic Cerebrospinal Venous Insufficiency (CCSVI) and the purported curative potential of venoplasty, (coined the ‘liberation’ procedure) Canadians living with multiple sclerosis (MS) began to travel abroad to receive the unregulated procedure, often placing them at odds with their health providers. The purpose of this study was to determine the factors influencing older MS patients’ decision to undergo the procedure in order to develop more specific and targeted health information. Methods We performed secondary analysis of data collected as part of the ‘Canadian Survey of Health Lifestyle and Aging with MS’ from people over the age of 55 years with MS symptoms for 20 or more years. The survey consisted of self-reported information on impairments, disability, participation, demographics, personal and environmental factors. In order to compare respondents who underwent the procedure to those who did not and to develop a predictive model, we created a comparison group using a case–control algorithm, controlling for age, gender and education, and matching procedure cases to controls 1:3. We used multivariate stepwise least likelihood regression of ‘a priori’ variables to determine predictive factors. Results The prevalence of the ‘liberation’ procedure in our sample was 12.8% (95/743), substantially lower than reported in previous studies of complementary/alternative treatments in MS. The predictive model contained five factors; living alone (Odds ratio 0.24, 95%CI 0.09-0.63), diagnosis of anxiety (Odds ratio 0.29, 95%CI 0.10 - 0.84), rating of neurologist’s helpfulness (Odds ratio 0.56, 95%CI 0.44 -0 .71), Body Mass Index (Odds ratio 0.93, 95%CI, 0.89 - 0.98) and perceived physical impact of MS (Odds ratio 1.02, 95%CI 1.01 - 1.04). Conclusions Predictive factors differed from previous studies of complementary/alternative treatment use likely due to both the invasiveness of the procedure and the advanced age of our study cohort. Our findings suggest that health professionals should target information on the risks and benefits of unregulated procedures to those patients who feel dissatisfied with their neurologist and they should include family members in discussions since they may be providing the logistical support to travel abroad and undergo the ‘liberation’ procedure. Our findings may be applicable to others with chronic disabling conditions who contemplate the user-pay unregulated invasive procedures available to them. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0835-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Ploughman
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada.
| | - Olivia J Manning
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada.
| | | | - Chelsea Harris
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada.
| | - Stephen H Hogan
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada.
| | - Nancy Mayo
- Clinical Epidemiology, McGill University, Montreal, QC, Canada.
| | - John D Fisk
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - A Dessa Sadovnick
- Department of Medical Genetics and Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Paul O'Connor
- Department of Neurology, St. Michaels Regional Hospital, Toronto, ON, Canada.
| | | | - Luanne M Metz
- Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
| | - Penelope Smyth
- Department of Neurology, University of Alberta, Edmonton, AB, Canada.
| | - Penelope W Allderdice
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University, Rm 400, L.A. Miller Centre, 100 Forest Rd, St. John's, NL, Canada.
| | - Susan Scott
- Clinical Epidemiology, McGill University, Montreal, QC, Canada.
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Mark Stefanelli
- Department of Neurology, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
| | - Marshall Godwin
- Primary Health Care Research Unit, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
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Mysak T, Sadowski CA, Foley HL, George-Phillips K. Recent trials in neurology that should influence your practice. Can Pharm J (Ott) 2015; 148:41-7. [DOI: 10.1177/1715163514560563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tania Mysak
- Pharmacy Services, Alberta Health Services (Mysak, George-Phillips), Edmonton
- Faculty of Pharmacy and Pharmaceutical Sciences (Mysak, Sadowski, George-Phillips), University of Alberta, Edmonton
- We Care Pharmacy, Windsor Regional Hospital (Foley), Windsor, Ontario
- University of Waterloo School of Pharmacy (Foley), Kitchener, Ontario
| | - Cheryl A. Sadowski
- Pharmacy Services, Alberta Health Services (Mysak, George-Phillips), Edmonton
- Faculty of Pharmacy and Pharmaceutical Sciences (Mysak, Sadowski, George-Phillips), University of Alberta, Edmonton
- We Care Pharmacy, Windsor Regional Hospital (Foley), Windsor, Ontario
- University of Waterloo School of Pharmacy (Foley), Kitchener, Ontario
| | - Heather L. Foley
- Pharmacy Services, Alberta Health Services (Mysak, George-Phillips), Edmonton
- Faculty of Pharmacy and Pharmaceutical Sciences (Mysak, Sadowski, George-Phillips), University of Alberta, Edmonton
- We Care Pharmacy, Windsor Regional Hospital (Foley), Windsor, Ontario
- University of Waterloo School of Pharmacy (Foley), Kitchener, Ontario
| | - Kirsten George-Phillips
- Pharmacy Services, Alberta Health Services (Mysak, George-Phillips), Edmonton
- Faculty of Pharmacy and Pharmaceutical Sciences (Mysak, Sadowski, George-Phillips), University of Alberta, Edmonton
- We Care Pharmacy, Windsor Regional Hospital (Foley), Windsor, Ontario
- University of Waterloo School of Pharmacy (Foley), Kitchener, Ontario
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46
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Tsivgoulis G, Faissner S, Voumvourakis K, Katsanos AH, Triantafyllou N, Grigoriadis N, Gold R, Krogias C. "Liberation treatment" for chronic cerebrospinal venous insufficiency in multiple sclerosis: the truth will set you free. Brain Behav 2015; 5:3-12. [PMID: 25722945 PMCID: PMC4321389 DOI: 10.1002/brb3.297] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/19/2014] [Accepted: 10/23/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Chronic cerebrospinal venous insufficiency (CCSVI) has recently been introduced as a chronic state of impaired cerebral or cervical venous drainage that may be causally implicated in multiple sclerosis (MS) pathogenesis. Moreover, percutaneous transluminal angioplasty of extracranial veins termed "Liberation treatment" has been proposed (based on nonrandomized data) as an alternative therapy for MS. METHODS A comprehensive literature search was conducted to identify available published, peer-reviewed, clinical studies evaluating (1) the association of CCSVI with MS, (2) the reproducibility of proposed ultrasound criteria for CCSVI detection (3) the safety and efficacy of "Liberation treatment" in open-label and randomized-controlled trial (RCT) settings. RESULTS There is substantial heterogeneity between ultrasound case-control studies investigating the association of CCSVI and MS. The majority of independent investigators failed to reproduce the initially reported high prevalence rates of CCSVI in MS. The prevalence of extracranial venous stenoses evaluated by other neuroimaging modalities (contrast or MR venography) is similarly low in MS patients and healthy individuals. One small RCT failed to document any benefit in MS patients with CCSVI receiving "Liberation treatment", while an exacerbation of disease activity was observed. "Liberation treatment" has been complicated by serious adverse events (SAEs) in open-label studies (e.g., stroke, internal jugular vein thrombosis, stent migration, hydrocephalus). CONCLUSION CCSVI appears to be a poorly reproducible and clinically irrelevant sonographic construct. "Liberation treatment" has no proven efficacy, may exacerbate underlying disease activity and has been complicated with SAEs. "Liberation treatment" should stop being offered to MS patients even in the settings of RCTs.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" Hospital, School of Medicine, University of Athens Athens, Greece ; International Clinical Research Center, Department of Neurology, St. Anne's University Hospital Brno, Czech Republic ; Department of Neurology, University of Tennessee Health Science Center Memphis, TN
| | - Simon Faissner
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Konstantinos Voumvourakis
- Second Department of Neurology, "Attikon" Hospital, School of Medicine, University of Athens Athens, Greece
| | - Aristeidis H Katsanos
- Department of Neurology, School of Medicine, University of Ioannina Ioannina, Greece
| | - Nikos Triantafyllou
- First Department of Neurology, "Eginition" Hospital, School of Medicine, University of Athens Athens, Greece
| | - Nikolaos Grigoriadis
- Department of Neurology, Laboratory of Experimental Neurology and Neuroimmunology, AHEPA Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany
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Kuchling J, Sinnecker T, Bozin I, Dörr J, Madai VI, Sobesky J, Niendorf T, Paul F, Wuerfel J. [Ultrahigh field MRI in context of neurological diseases]. DER NERVENARZT 2014; 85:445-58. [PMID: 24549692 DOI: 10.1007/s00115-013-3967-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Ultrahigh field magnetic resonance imaging (UHF-MRI) has recently gained substantial scientific interest. At field strengths of 7 Tesla (T) and higher UHF-MRI provides unprecedented spatial resolution due to an increased signal-to-noise ratio (SNR). The UHF-MRI method has been successfully applied in various neurological disorders. In neuroinflammatory diseases UHF-MRI has already provided a detailed insight into individual pathological disease processes and elucidated differential diagnoses of several disease entities, e.g. multiple sclerosis (MS), neuromyelitis optica (NMO) and Susac's syndrome. The excellent depiction of normal blood vessels, vessel abnormalities and infarct morphology by UHF-MRI can be utilized in vascular diseases. Detailed imaging of the hippocampus in Alzheimer's disease and the substantia nigra in Parkinson's disease as well as sensitivity to iron depositions could be valuable in neurodegenerative diseases. Current UHF-MRI studies still suffer from small sample sizes, selection bias or propensity to image artefacts. In addition, the increasing clinical relevance of 3T-MRI has not been sufficiently appreciated in previous studies. Although UHF-MRI is only available at a small number of medical research centers it could provide a high-end diagnostic tool for healthcare optimization in the foreseeable future. The potential of UHF-MRI still has to be carefully validated by profound prospective research to define its place in future medicine.
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Affiliation(s)
- J Kuchling
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland
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Gadda G, Taibi A, Sisini F, Gambaccini M, Zamboni P, Ursino M. A new hemodynamic model for the study of cerebral venous outflow. Am J Physiol Heart Circ Physiol 2014; 308:H217-31. [PMID: 25398980 DOI: 10.1152/ajpheart.00469.2014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We developed a mathematical model of the cerebral venous outflow for the simulation of the average blood flows and pressures in the main drainage vessels of the brain. The main features of the model are that it includes a validated model for the simulation of the intracranial circulation and it accounts for the dependence of the hydraulic properties of the jugular veins with respect to the gravity field, which makes it an useful tool for the study of the correlations between extracranial blood redistributions and changes in the intracranial environment. The model is able to simulate the average pressures and flows in different points of the jugular ducts, taking into account the amount of blood coming from the anastomotic connections; simulate how the blood redistribution due to change of posture affects flows and pressures in specific points of the system; and simulate redistributions due to stenotic patterns. Sensitivity analysis to check the robustness of the model was performed. The model reproduces average physiologic behavior of the jugular, vertebral, and cerebral ducts in terms of pressures and flows. In fact, jugular flow drops from ∼11.7 to ∼1.4 ml/s in the passage from supine to standing. At the same time, vertebral flow increases from 0.8 to 3.4 ml/s, while cerebral blood flow, venous sinuses pressure, and intracranial pressure are constant around the average value of 12.5 ml/s, 6 mmHg, and 10 mmHg, respectively. All these values are in agreement with literature data.
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Affiliation(s)
- G Gadda
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy;
| | - A Taibi
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - F Sisini
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - M Gambaccini
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - P Zamboni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy; and
| | - M Ursino
- Department of Electrical, Electronic and Information Engineering, University of Bologna, Bologna, Italy
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Ultrasonographic evaluation of cerebral arterial and venous haemodynamics in multiple sclerosis: a case-control study. PLoS One 2014; 9:e111486. [PMID: 25360597 PMCID: PMC4216015 DOI: 10.1371/journal.pone.0111486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/22/2014] [Indexed: 11/28/2022] Open
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. Material and 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.
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50
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Recommendations for Multimodal Noninvasive and Invasive Screening for Detection of Extracranial Venous Abnormalities Indicative of Chronic Cerebrospinal Venous Insufficiency: A Position Statement of the International Society for Neurovascular Disease. J Vasc Interv Radiol 2014; 25:1785-94.e17. [DOI: 10.1016/j.jvir.2014.07.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 11/19/2022] Open
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