Hemodynamic patterns of chronic cerebrospinal venous insufficiency in multiple sclerosis. Correlation with symptoms at onset and clinical course

Int Angiol. 2010 Apr;29(2):183-8.


Aim: Chronic cerebrospinal venous insufficiency (CCSVI) is associated with multiple sclerosis (MS). CCSVI is detected by transcranial and extracranial color-Doppler high-resolution examination (TCCS-ECD) and venography that permit to identify five types of venous malformations and four major (A-D) hemodynamic patterns of anomalous extracranial-extravertebral venous outflow. We investigated possible correlation between such hemodynamic patterns and both the symptoms at onset and clinical course in patients with MS and CCSVI.

Methods: TCCS-ECD, selective venography and clinical records of 65 patients affected by definite MS and CCSVI were reviewed.

Results: The four hemodynamic patterns of CCSVI were unevenly (P<0.0001) distributed with respect to the types of clinical presentation and course. In particular the Type A or B patterns were common in patients with onset of optic neuritis, but rare in patients presenting with spinal cord symptoms who typically showed a type D pattern. As well, the type A or type B hemodynamic were more common in patients with relapsing remitting course than in patients with secondary progressive course and rare in patients with primary progressive course. The C hemodynamic pattern was not observed in patients with primary progressive course who showed a remarkable prevalence of the type D pattern.

Conclusion: The distribution of venous malformations and the resulting hemodynamic pattern show correlation with symptoms at onset and clinical course in patients with MS and CCSVI.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Azygos Vein / abnormalities
  • Azygos Vein / physiopathology*
  • Cerebral Veins / physiopathology
  • Chronic Disease
  • Constriction, Pathologic
  • Disease Progression
  • Female
  • Hemodynamics*
  • Humans
  • Jugular Veins / abnormalities
  • Jugular Veins / physiopathology*
  • Male
  • Multiple Sclerosis / diagnosis
  • Multiple Sclerosis / physiopathology*
  • Multiple Sclerosis, Chronic Progressive / diagnosis
  • Multiple Sclerosis, Chronic Progressive / physiopathology
  • Multiple Sclerosis, Relapsing-Remitting / diagnosis
  • Multiple Sclerosis, Relapsing-Remitting / physiopathology
  • Optic Neuritis / diagnosis
  • Optic Neuritis / physiopathology
  • Phlebography
  • Retrospective Studies
  • Severity of Illness Index
  • Spinal Cord / blood supply
  • Ultrasonography, Doppler, Color
  • Vascular Malformations / diagnosis
  • Vascular Malformations / physiopathology*
  • Venous Insufficiency / diagnosis
  • Venous Insufficiency / physiopathology*