The role of extracranial venous abnormalities in neurological disease / 中风与神经疾病杂志

@#Compared with arteries, the extracranial venous system is characterized by complexity, individual variability and frequent asymmetry, and moreover, it is easily affected by other factors such as respiration, postural change, cardiac function, and surrounding structures. In the past, abnormal development or variation of the extracranial venous system was considered non-pathological and has not been taken seriously; however, an increasing number of evidence has shown that extracranial venous insufficiency does have important pathophysiological consequences in various central nervous system disorders. Several central nervous system disorders are associated with the presence and severity of jugular venous reflux. Chronic cerebrospinal venous insufficiency, as a vascular disease based on comprehensive ultrasound criteria, has aroused the interest in the physiology and pathology of venous reflux. The association between such diseases and central nervous system disorders remains unknown and requires further research. By summarizing current concepts and the latest research findings, this article elaborates on the structural features and physiological function of the extracranial venous system, as well as the potential role of cervical veins in central nervous system disorders.

Cerebrospinal Fluid Dynamics in Patients with Multiple Sclerosis: The Role of Phase-Contrast MRI in the Differential Diagnosis of Active and Chronic Disease

OBJECTIVE: Multiple sclerosis (MS) is an inflammatory disease characterized by demyelinating plaques in the white matter. Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a new hypothesis for the etiopathogenesis of MS disease. MS-CCSVI includes a significant decrease of cerebrospinal fluid (CSF) flow through the cerebral aqueduct secondary to an impaired venous outflow from the central nervous system. This study aimed to determine whether CSF flow dynamics are affected in MS patients and the contributions to differential diagnosis in active and chronic disease using phase-contrast magnetic resonance imaging (PC-MRI). MATERIALS AND METHODS: We studied 16 MS patients with chronic plaques (group 1), 16 MS patients with active plaques-enhanced on MRI (group 2), and 16 healthy controls (group 3). Quantitatively evaluation of the CSF flow was performed from the level of the cerebral aqueduct by PC-MRI. According to heart rates, 14–30 images were obtained in a cardiac cycle. Cardiac triggering was performed prospectively using finger plethysmography. RESULTS: No statistically significant difference was found between the groups regarding average velocity, net forward volume and the average flow (p > 0.05). Compared with the controls, group 1 and group 2, showed a higher peak velocity (5.5 ± 1.4, 4.9 ± 1.0, and 4.3 ± 1.3 cm/sec, respectively; p = 0.040), aqueductal area (5.0 ± 1.3, 4.1 ± 1.5, and 3.1 ± 1.2 mm2, respectively; p = 0.002), forward volume (0.039 ± 0.016, 0.031 ± 0.013, and 0.021 ± 0.010 mL, respectively; p = 0.002) and reverse volume (0.027 ± 0.016, 0.018 ± 0.009, and 0.012 ± 0.006 mL, respectively; p = 0.000). There were no statistical significance between the MS patients with chronic plaques and active plaques except for reverse volume. The MS patients with chronic plaques showed a significantly higher reverse volume (p = 0.000). CONCLUSION: This study indicated that CSF flow is affected in MS patients, contrary to the hypothesis that CCSVI-induced CSF flow decreases in MS patients. These findings may be explained by atrophy-dependent ventricular dilatation, which may occur at every stage of MS.

Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis: A Failed Concept

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.

The morphologic and hemodynamic abnormalities study of jugular vein in volunteers / 实用放射学杂志

Objective To investigate jugular vein morphological changes with three dimension phase contrast magnetic resonance venography(3D PC MRV),and to explore hemodynamic features using MR phase contrast cine (MR PC cine).Methods Sixty-five healthy volunteers performed 3D PC MRV and MR PC-cine sannings.MRV ranged from torcular herophili to brachiocephalic veins, and the raw data of PC-cine was acquired at cervical 2-3(C2-C3)level perpendicular to the Jugular veins(JVs)with the maximum encoding velocity of 50 cm/sec.Jugular vein showing absent or tip shape(cross-sectional area less than 12.5 mm2 )was considered abnormal,and flat,crescent,oval,round shapes were considered normal.Data of PC-cine was processed by computer to evaluate the hemodynamic features.Results Nine (13.85%)of 65 cases were abnormal that unilateral jugular vein showing needle-pointed narrow or absent,and 8 cases on the left,and one case on the right;Weak correlation was found between jugular veins pattern and the age.The right sided values in volunteers were higher than that of the left side.Conclusion The morphology and hemodynamics of jugular veins in volunteers showed significant difference between sides,and weak correlation is found between the morphology and aging.

Procedimientos endovasculares como tratamiento de la esclerosis múltiple?: la hipótesis de la insuficiencia venosa crónica cerebro medular: [revisión] / Endovascular procedures as multiple sclerosis treatment?: the hipothesis of the chronic cerebrospinal venous insufficiency: [review]

In this "point of view" or special article, it has been reviewed the main bibliographic antecedents related to the entity denominated as chronic cerebrospinal venous insufficiency (CCSVI), which formulation has been stated by Zamboni et col, from the Vascular Diseases Center of the University of Ferrara-Italy, who have assigned it a pathogenic role or of aggravation one in Multiple Sclerosis (MS), what has led them to propose and carry out endovascular balloon angioplasty or venous stent in MS patients as a treatment. The bibliographic review at this stage of the knowledge of CCSVI does not let us to conclude whether this hypothetical entity has any role in the development or aggravation of MS. On the other hand, we agree with most of the clinicians and neuroimaging MS researchers because of the absence of arguments to indicate, support or propose envovascular "therapeutic" procedures for MS. To advance in the knowledge of CCSVI and the eventual relation with MS it is required some multicentric controlled studies carefully led and clinical and methodological rigorous procedures approved by committee of ethic in very well informed patients invited to participate in protocols of formal investigation who should be protected by complementary pertinent insurances and responsibilities connected to the investigation expenses.

En este artículo especial de la modalidad "puntos de vista", se revisan los antecedentes bibliográficos principales relacionados a la entidad denominada "Insuficiencia venosa crónica cerebro medular (IVCCM)" cuya formulación ha sido planteada por Zamboni y col, del Centro de Enfermedades Vasculares de la Universidad de Ferrara-Italia quienes le han adjudicado un rol patogénico o de agravación en la Esclerosis Múltiple (EM), que les ha llevado a proponer y realizar procedimientos de angioplastía mediante balón endovascular o stent venoso en pacientes con EM. La revisión de la bibliografía, en esta etapa del conocimiento de la IVCCM, no permite concluir si esta hipotética entidad tiene algún rol en el desarrollo o agravación de la EM. Por otro lado, concordamos con la mayoría de los clínicos e imagenólogos dedicados al estudio y tratamiento de la EM, en la ausencia de argumentos para indicar, alentar o propiciar procedimientos "terapéuticos" endovasculares para la EM. Para avanzar, en el conocimiento de la IVCCM y de eventual relación con la EM, se requieren estudios multicéntricos cuidadosamente conducidos, clínica y metodológicamente rigurosos, aprobados por comités de ética, en pacientes que sean invitados informadamente a participar en protocolos de investigación formales, que cuenten con las protecciones de seguros complementarios pertinentes y responsabilidades del gasto a costas de los investigadores.