Chronic cerebro-spinal insufficiency in multiple sclerosis and meniere disease: same background, different patterns?

Abstract

Multiple sclerosis (MS) is a chronic disease of the central nervous system characterized by demyelinating lesions with acute phases and progressive loss of sensorimotor functions. Mèniére disease (MD) is a disorder of the inner ear characterized by acute spells of vertigo and hearing loss and progressive loss of cochleo-vestibular function. Both the diseases have a multifactorial pathogenesis and quite the same chronic cerebro-spinal insufficiency (CCSVI) frequency. However, as far as Author's knowledge concerns, no patients affected with both diseases are described so far. The aim of this paper is to investigate whether MS and MD present different CCSVI patterns. Three groups of patients were enrolled: 60 definite MS -27 definite unilateral MD (MEN) -41 with other no-Mèniére, audiovestibular disorders (OVD). All subjects underwent magnetic resonance venography (MRV) and venous Duplex (ECD) and only patients that satisfied both MRV and ECD CCSVI diagnostic criteria were considered. J1 was normal in 57% of MS, 88% of MEN and 95% of OVD. Stenosis (ST) were detected, respectively, in 30% of MS and 2% in MEN and OVD. J2 was normal in 78% of MS, 64% of MEN and 95% of OVD. At this level alterations of the trunk (AT) were detected in 17% in MS and 26% in MEN; J3 was normal in 74% of MS, 64% of MEN and 86% of OVD. AT were found in 15% of MS, 26% of MEN and 8% of OVD. Hyperplasia of the Vertebral Veins was observed in 35% of MS, 40% of MEN and in 15% of OVD. Other compensatory collaterals were detected in 25% in MS and only in 5% in MEN and OVD. Our results indicate that the MS pattern is characterized by J1 stenosis, J2 trunk alterations, a prevalence of J1-J2 medial-distal alterations, compensatory collaterals besides vertebral venous system. MD pattern is characterized by trunk alteration in J3, a prevalence of J3-J2 medial-proximal alterations and vertebral veins hyperplasia without other detectable collaterals. Although the group of patients with venous alterations is very small, OVD patients show a CCSVI pattern that is more similar to MD than MS pattern. The difference between MS and MD patterns indicates that CCSVI is not a unique entity and it could be an explanation of the fact that subjects affected with both the diseases are not reported.

The omohyoid and sternocleidomastoid muscles entrapment of the internal jugular vein: Which role in Mèniére disease patients? Treatment perspective description

“…The elevation of hydrostatic pressure, due to venous outflow obstruction, the chronic venous stasis and the damage of stria vascularis increase the fluid from the capillaries into the endolymphatic space in a mechanism involved in MèS. 9 Recently, Bavera et al assessed the presence of cerebral outflow anomalies in both, a population affected by MS and a population affected by Mès, demonstrating that not only there was a high prevalence of these anomalies in these two populations compared to a control population, 10 but also and above all that there were different patterns in the two pathologies.…”

Dario Alpini, a pioneer of venous and lymphatics disorders of the inner ear

“…[1][2][3][4][5][6] His Patients and Friends all loved him for his patience and presence, together with a wonderful temper and a friendly word for all. Those who knew him well also appreciated his capacity for intuitions and ideas.…”