The relation between the cerebrovascular system and multiple sclerosis (MS) lesions had first been documented in 1863 by Rindfleisch et al. 1 and later revisited by Dow et al. in the mid-1900. 2 It was hypothesized that MS lesion formation depends on the entry of inflammatory cells from the systemic circulation into the brain parenchyma possibly from a disrupted endothelium of venules. 3-5 More recently, the presence of a "central vein sign" (CVS) on MRI has been introduced as a biomarker for the diagnosis of MS. 6 Indeed, several studies have shown that CVS has the ability to accurately differentiate MS from other white matter diseases such as neuromyelitis optica spectrum disorder, 7 systemic autoimmune diseases (Behçet syndrome, systemic lupus erythematosus, and antiphospholipid syndrome), 8