Anatomical stenosis of the internal jugular veins: supportive evidence of CCSVI in Multiple Sclerosis?

Alessandro Rasman

In recent months there is an ongoing debate in the International scientific community about the recent theory of Dr Paolo Zamboni, Director of Vascular Diseases Center, University of Ferrara, on the relationship between multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI) discovered by him during his studies lasted nearly a decade and published two years ago.

The debate is concentrated among those who consider this a plausible hypothesis thanks to the many diagnostic findings in patients with multiple sclerosis using Doppler ultrasound examination also with venoplasty which is used to treat internal jugular vein stenosis.

Some opponents to this hypothesis are trying to deny the existence of CCSVI as pathology, as if to prove that Dr Zamboni and his colleagues dreamed CCSVI at night...

This in part has happened again during the conference in Munich of Cardiovascular and Interventional Radiological Society of Europe.

It is very useful to read a recent letter, published on the website of the Journal of Neurololgy, Neurosurgery & Psychiatry in April 28, 2011 and completely ignored by the media, by a group of researchers of the National Institute for Infectious Diseases "L. Spallanzani" of Rome coordinated by the pathologist Dr Andrea Baiocchini and entitled "Anatomical stenosis of the internal jugular veins: supportive evidence of chronic cerebrospinal venous insufficiency?".

The authors reported that they performed complete post-mortem examination of two patients with MS, died for different causes. One patient, a 74 year-old-woman, was hospitalized for acute respiratory illness and died because of bacterial pneumonia; the other one, a 35 year-old-woman, died for otogenic bacterial meningitis complicated with internal jugular thrombosis as demonstrated on MR venography.

Postmortem examination demonstrated in both patients a marked stenosis of left internal jugular vein. Venous flow slowing, caused by the stenosis, had predisposed to internal jugular vein thrombosis, histologically demonstrated in the second case.

The authors were able to demonstrate the presence of anatomical alteration in the veins of the neck with impaired venous drainage from the central nervous system in two patients with multiple sclerosis who died from other causes.

The authors write, to not know the exact implications in MS pathology and certainly there is no doubt that this area warrants a great deal more study. According to them clinical trials for evaluating new therapeutic agents and other clinical experimental protocols may be required.

The debate thus continues, but it seems that this theory is entirely plausible.

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