ANNALS of Neurology

http://onlinelibrary.wiley.com/doi/10.1002/ana.22451/abstract

http://www.ncbi.nlm.nih.gov/pubmed/21674590

LETTER TO THE EDITOR
Chronic Cerebrospinal Venous Insufficiency and
Susceptibility to Multiple Sclerosis
Avruscio Giampiero, MD

Article first published online: 14 JUN 2011

I read carefully the article published in the January 2011 issue
of Annals of Neurology by Baracchini and colleagues on the
prevalence of chronic cerebrospinal venous insufficiency
(CCSVI) measured with echo color Doppler sonography in
patients with high suspicion of initial multiple sclerosis (MS).1
These authors give us 2 very important data that appear underestimated
in their report, but are of extreme importance in the
scientific debate in progress. In Table 4, they show positive
CCSVI Doppler screening in 2% of controls matched for age
and gender versus 16% of patients with possible MS. This
means that:
• The prevalence of CCSVI in healthy people is 2%, confirming
Zamboni’s data,2 with rates far removed from the 22%
recently reported by Zivadinov et al.3
• The risk of having possible MS is dramatically increased by
the presence of CCSVI by >9-fold (odds ratio, 9.3; 95%
confidence interval, 1.1–78; p ¼ 0.0180).
In contrast to the conclusions of the authors, careful analysis
of their results indicates that CCSVI may be among the
factors contributing to the development of MS symptoms at
onset.

Potential Conflicts of Interest
Nothing to report.

Department of Vascular Medicine, Sant’Antonio Hospital,
Padua, Italy

REFERENCES
1. Baracchini C, Perini P, Calabrese M, et al. No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset. Ann Neurol 2011;69:90–99.
2. Zamboni P, Galeotti R, Menegatti E, et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2009;80:392–399.
3. Zivadinov R, Marr K, Cutter G, et al. Prevalence, sensitivity and specificity of chronic cerebrospinal venous insufficiency in multiple sclerosis. Neurology (WNL.0b013e318212a901; published ahead of print April 13, 2011).

DOI: 10.1002/ana.22451 VC 2011 American Neurological Association 1