Abnormal venous postural control: multiple sclerosis-specific change related to gray matter pathology or age-related neurodegenerative phenomena?

Clin Auton Res. 2019 Jun;29(3):329-338. doi: 10.1007/s10286-018-0555-6. Epub 2018 Aug 17.


Background: Autonomic nervous system dysfunction has been previously observed in multiple sclerosis (MS) patients.

Objective: To assess associations between magnetic resonance imaging-detected neuroinflammatory and neurodegenerative pathology and postural venous flow changes indicative of autonomic nervous system function.

Methods: We used a standardized 3T magnetic resonance imaging protocol to scan 138 patients with MS and 49 healthy controls. Lesion volume and brain volumes were assessed. The cerebral venous flow (CVF) was examined by color-Doppler sonography in supine and upright positions and the difference was calculated as ΔCVF. Based on ΔCVF, subjects were split into absolute or quartile groups. Student's t test, χ2-test, and analysis of covariance adjusted for age and sex were used accordingly. Benjamini-Hochberg procedure corrected the p-values for multiple comparisons.

Results: No differences were found between healthy controls and patients with MS in both supine and upright Doppler-derived CVF, nor in prevalence of abnormal postural venous control. Patients with absolute negative ΔCVF had higher disability scores (p = 0.013), lower gray matter (p = 0.039) and cortical (p = 0.044) volumes. The negative ΔCVF MS group also showed numerically worse bladder/bowel function when compared to the positive ΔCVF (2.3 vs. 1.5, p = 0.052). Similarly, the lowest quartile ΔCVF MS group had higher T1-lesion volumes (p = 0.033), T2-lesion volumes (p = 0.032), and lower deep gray matter (p = 0.043) and thalamus (p = 0.033) volumes when compared to those with higher ΔCVF quartiles.

Conclusion: No difference in postural venous outflow between patients with MS and healthy controls was found. However, when the abnormal ΔCVF is present within the MS population, it may be associated with more inflammatory and neurodegenerative pathology. Further studies should explore whether the orthostatic venous changes are an aging or an MS-related phenomenon and if the etiology is due to impaired autonomic nervous system functioning.

Keywords: ANS; Brain atrophy; Inflammation; MRI; Multiple sclerosis; Venous flow.

MeSH terms

  • Adult
  • Aged
  • Aging / pathology*
  • Aging / physiology
  • Blood Flow Velocity / physiology
  • Brain / blood supply
  • Brain / diagnostic imaging*
  • Cerebral Veins / diagnostic imaging*
  • Cerebral Veins / physiopathology
  • Cerebrovascular Circulation / physiology
  • Female
  • Gray Matter / blood supply
  • Gray Matter / diagnostic imaging*
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Multiple Sclerosis / diagnostic imaging*
  • Multiple Sclerosis / physiopathology
  • Neurodegenerative Diseases / diagnostic imaging*
  • Neurodegenerative Diseases / physiopathology
  • Postural Balance / physiology
  • Ultrasonography, Doppler, Transcranial / methods