Chronic Cerebrospinal Venous Insufficiency (CCSVI) IN Meniere Disease. Case or Cause?

Alpini D.C.(1), Bavera P.M.(2), Hahn A.(3), Mattei V.(1)
1) Sc. Institute S. Maria Nascente,“Don Carlo Gnocchi” Foundation, via Capecelatro 66, 20148 Milan, Italy
2) Medick-Up Angiology Center via Monte Rosa 13 tel. +39024985581, Milan, Italy
3) ENT dept. III Medical Faculty, Prague (Czech Republik)

Abstract

CCSVI is the acronym for Chronic Cerebrospinal Venous Insufficiency, initially described by P. Zamboni, as being strongly associated with multiple sclerosis (MS). It is a syndrome characterized by stenosis of the internal jugular veins (IJVs) and/or azygous vein (AZ) with opening of collaterals and insufficient drainage. Bavera PM carried out 823 Duplex exams on a control group of 60 patients without MS. As expected CCSVI was found only in few subjects of the control group, three, two females and one male, but all affected with Sudden Sensorineural Hearing Loss (SSHL). Successively, we reported a case of bilateral SSHL with vertigo, showing evidence of the CCSVI pattern at Duplex examination (not associated with MS). To the best of the authors’ knowledge, this kind of association has never been reported. We studied 52 patients affected with cochleo-vestibular disturbances subdivided into two groups of out-patients:Definite unilateral Meniere (Men): 12 subjects (8 males and 4.females, mean age 41,6.yy) according to international AOO-HNS 1995 diagnostic criteria - No-Meniere (No-Men): 14 subjects (6.males and 8 females, mean age 44,7.yy) affected with unilateral cocleo-vestibular impairment A third group of subjects have been considered, as a “normal” group, 13 patients (8 females and 5 males, mean age 45,5 yy) affected with Benign Paroxismal Positioning Vertigo (BPPV) with cochlear involvement Asymmetrical artherious flow in VA or CA was revealed in 2 Men 9 no-Men and 1 BPPV, respectively 12,5 - 60,7 - and 8,6 %. Differences between Men and No-Men and between each of this group with respect to BPPV were highly significant (p<0.001). Asymmetrical venous flow in IJV or VV was detected in 9 patients in MEN group and in 4 in no-MEN and 2 BPPV, respectively 79 - 28,5 and 13 %. Differences between Men and No-Men and between each of this group with respect to BBV were highly significant (p<0.001).
Source: ScienceMED, vol. 4, 1.2013, 9-15, Bologna (Italy)