Abstract

AIM: The aim of this open-label study was to assess extracranial Doppler
criteria of chronic cerebrospinal venous insufficiency in multiple

sclerosis patients.

METHODS: Seventy patients were assessed: 49 with relapsing-remitting, 5 with primary
progressive and 16 with secondary progressive multiple sclerosis. The

patients were aged 15-58 years and they suffered from multiple sclerosis

for 0.5-40 years. Sonographic signs of abnormal venous outflow were

detected in 64 patients (91.4%).

RESULTS: We found at least two of four extracranial criteria in 63 patients
(90.0%), confirming that multiple sclerosis is stronghly associated with

chronic cerebrospinal venous insufficiency. Additional transcranial

investigations may increase the rate of patients found positive in our

survey. Reflux in internal jugular and/or vertebral veins was present in

31 cases (42.8%), stenosis of internal jugular veins in 61 cases

(87.1%), not detectable flow in internal jugular and/or vertebral veins

in 37 cases (52.9%) and negative difference in cross-sectional area of

the internal jugular vein assessed in the supine vs. sitting position in

28 cases (40.0%). Flow abnormalities in the vertebral veins were found

in 8 patients (11.4%). Pathologic structures (membranaceous or netlike

septa, or inverted valves) in the junction of internal jugular vein with

brachiocephalic vein were found in 41 patients (58.6%), in 15 patients

(21.4%) on one side only and in 26 patients (37.1%) bilaterally.

CONCLUSION: Multiple sclerosis is highly correlated with chronic cerebrospinal venous
insufficiency. These abnormalities in the extracranial veins draining

the central nervous system can exist in various combinations. The most

common pathology in our patients was the presence of an inverted valve

or another pathologic structure (like membranaceous or netlike septum)

in the area of junction of the IJV with the brachiocephalic vein.