Internal Jugular Vein Blood Flow in Multiple Sclerosis Patients and Matched Controls

Mancini, Marcello; Lanzillo, Roberta; Liuzzi, Raffaele; Donato, Orlando Di; Ragucci, Monica; Monti, Serena; Salvatore, Elena; Morra, Vincenzo Brescia; Salvatore, Marco

doi:10.1371/journal.pone.0092730

Cited by 21 publications

(24 citation statements)

References 45 publications

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“…This work is one of the recent studies concerning the relations among the main cerebral venous outflow routes, their disorders, and the occurrence of neurological diseases (10,17,19,28,29,34).…”

Section: Resultsmentioning

confidence: 99%

A new hemodynamic model for the study of cerebral venous outflow

Gadda

Taibi

Sisini

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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We developed a mathematical model of the cerebral venous outflow for the simulation of the average blood flows and pressures in the main drainage vessels of the brain. The main features of the model are that it includes a validated model for the simulation of the intracranial circulation and it accounts for the dependence of the hydraulic properties of the jugular veins with respect to the gravity field, which makes it an useful tool for the study of the correlations between extracranial blood redistributions and changes in the intracranial environment. The model is able to simulate the average pressures and flows in different points of the jugular ducts, taking into account the amount of blood coming from the anastomotic connections; simulate how the blood redistribution due to change of posture affects flows and pressures in specific points of the system; and simulate redistributions due to stenotic patterns. Sensitivity analysis to check the robustness of the model was performed. The model reproduces average physiologic behavior of the jugular, vertebral, and cerebral ducts in terms of pressures and flows. In fact, jugular flow drops from ϳ11.7 to ϳ1.4 ml/s in the passage from supine to standing. At the same time, vertebral flow increases from 0.8 to 3.4 ml/s, while cerebral blood flow, venous sinuses pressure, and intracranial pressure are constant around the average value of 12.5 ml/s, 6 mmHg, and 10 mmHg, respectively. All these values are in agreement with literature data. mathematical modeling; cerebral outflow; posture dependence; jugular veins collapse; collateral routes THE EXTRACRANIAL VENOUS SYSTEM represents an important determinant of the brain circulation, but its role in the pathology of the central nervous system is not fully understood yet (4,26). It is recognized that, in supine position, the jugular veins represent the main outflow route for the cerebral circulation (2,6,25,36,38), being able to carry most of blood flow from the brain and from other extracerebral territories (ϳ700 -720 ml/ min; Refs. 27, 33) with respect to a cerebral blood inflow of ϳ750 ml/min (45). However, the jugular venous system exhibits important flow limitation during upright posture changes, because the jugular veins tend to collapse as a consequence of the decrease of transmural pressure due to the gravitational field, causing a significant increase in resistance (3,7,12,14,26). In the absence of other routes for extracranial outflow, this flow limitation would have dramatic effects on the cerebral circulation, since, apart from brief transient time intervals, the average cranial arterial inflow is expected to be equal to the cranial venous outflow for the mass preservation.As a consequence, large attention has been devoted to the venous circulation in the upright state, in an effort to understand which alternative routes can carry the brain venous outflow. It has long been postulated that the vertebral venous system may provide an important alternative route for venous outflow when standing or sitting; this was f...

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Section: Resultsmentioning

confidence: 99%

A new hemodynamic model for the study of cerebral venous outflow

Gadda

Taibi

Sisini

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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“…Almost 80% of MS patients showed a delayed clearance time in at least one IJV [53]. This result was mirrored by Mancini et al by the means of contrast enhanced ultrasound, which demonstrate a significant reduction of clearance time in the IJV of MS patients respect to healthy controls, when injected with standardized contrast micro bubbles [54]. Interestingly these Authors also found a significant inverted correlation between the delayed IJV contrast clearance and the level of disability, since slower flow corresponded to higher expanded disability severity score.…”

Section: Cerebral Venous Drainage Consequences Of Ijv Pathologymentioning

confidence: 72%

The Pathology of the Internal Jugular Vein Wall in Multiple Sclerosis

Pedriali¹,

Zamboni²

2015

J Mult Scler

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In the last years it has been described a condition named Chronic Cerebrospinal Venous Insufficiency (CCSVI), frequently but not exclusively associated to Multiple Sclerosis (MS), which generated a strong scientific controversy about the epidemiological prevalence and the possible role in the complex, multi-factorial MS ethio-pathogenesis.However, CCSVI description also stimulated a considerable research activity on the extracranial veins. Among the fields of interest, the pathology of the Internal Jugular Veins (IJVs) was deeply investigated by some groups, so improving our knowledge in an underestimated field of MS research. Currently, the available papers clearly show the presence of abnormalities in the IJV wall of MS patient's respect to control tissue. In the tunica intima a significant derangement and loss of the endothelial cells have been described. Interestingly scanning electronic microscopy showed absence of endothelium in the defective jugular valves. In the adventitia it has been described an inverted ratio between type I and type III collagen, with prevalence of the latter. Finally, in the adventitia layer it has been found the presence of calcifications arranged around the vena venarum. Assessment of immune cells in the three IJV layers did not demonstrate increased infiltration. Current studies do not clarify the origin of the pathology of the IJV in patients with MS. Congenital, infectious, or even post thrombotic ethiology have been advocated. Finally, the review summarizes studies which link the CCSVI pathophysiology to the complex MS pathogenesis, and particularly to the impact of restricted brain outflow on the cerebral spinal fluid dynamics and cerebral perfusion.

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“…7 On the other hand, by using quantitative Doppler ultrasound measurements of the venous blood flow, several studies showed global venous hemodynamic differences associated with MS. A contrast-enhanced ultrasonography study showed heterogeneity in the venous outflow system consistent with slow washout dynamic. 22 All the aforementioned changes have been previously described as part of chronic cerebrospinal venous insufficiency (CCSVI) condition which is characterized by anomalies of the main extracranial cerebrospinal venous routes that interfere with normal blood outflow. 2 Higher prevalence of CCSVI has been reported not only in MS patients, but also in Parkinson disease, 24 and Meniere disease.…”

Section: Discussionmentioning

confidence: 99%

Global and regional brain atrophy is associated with low or retrograde facial vein flow in multiple sclerosis

Jakimovski

Marr

Mancini

et al. 2017

Veins and Lymphatics

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Increased collateral facial vein (FV) flow may be associated with structural damage in patients with multiple sclerosis (MS). The objective was to assess differences in FV flow and magnetic resonance imaging (MRI)-derived outcomes in MS. The study included 136 MS patients who underwent neck and head vascular system examination by echo-color Doppler. Inflammatory MRI markers were assessed on a 3T MRI using a semi-automated edge detection and contouring/thresholding technique. MRI volumetric outcomes of whole brain (WB), gray matter (GM), white matter (WM), cortex, ventricular cerebrospinal fluid (vCSF), deep gray matter (DGM), thalamus, caudate nucleus (CN), putamen, globus pallidus (GP), and hippocampus were calculated. Independent t-test and ANCOVA, adjusted for age, were used to compare groups based on FV flow quartiles. Thirty-four MS patients with FV flow ≤327.8 mL/min (lowest quartile) had significantly lower WB (P<0.001), WM (P<0.001), thalamus (P=0.004), cortex (P=0.004), GM (P=0.004), DGM (P=0.008), hippocampus (P=0.005), and GP volumes (P=0.044) compared to 102 patients with FV flow of >327.8 mL/min (higher quartiles). There were no differences in T1-, T2-and gadolinium-enhancing lesion volumes between the quartile groups.The lack of an association between FV blood flow and inflammatory MRI measures in MS patients, but an association with brain atrophy, suggests that the severity of neurodegenerative process may be related to hemodynamic alterations. MS patients with more advanced global and regional brain atrophy showed low or retrograde FV volume flow.

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Internal Jugular Vein Blood Flow in Multiple Sclerosis Patients and Matched Controls

Cited by 21 publications

References 45 publications

A new hemodynamic model for the study of cerebral venous outflow

A new hemodynamic model for the study of cerebral venous outflow

The Pathology of the Internal Jugular Vein Wall in Multiple Sclerosis

Global and regional brain atrophy is associated with low or retrograde facial vein flow in multiple sclerosis

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