Morphological and haemodynamic abnormalities in the jugular veins of patients with multiple sclerosis

Radak, Djordje; Kolár, J; Tanasković, Slobodan; Sagić, Dragan; Antonić, Želimir; Mitrasinovic, Anka; Babić, Silvija; Nenezić, Dragoslav; Ilijevski, Nenad

doi:10.1258/phleb.2011.011004

Cited by 25 publications

(21 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even those DS studies which detected a significant difference for CCSVI diagnosis between MS patients and the controls, reported a substantially lower prevalence than was originally reported [30,31,83,88,90,92-94,98,99]. …”

Section: Noninvasive Imaging Modalitiesmentioning

confidence: 62%

The role of noninvasive and invasive diagnostic imaging techniques for detection of extra-cranial venous system anomalies and developmental variants

Dolić

Siddiqui

Karmon

et al. 2013

BMC Med

View full text Add to dashboard Cite

The extra-cranial venous system is complex and not well studied in comparison to the peripheral venous system. A newly proposed vascular condition, named chronic cerebrospinal venous insufficiency (CCSVI), described initially in patients with multiple sclerosis (MS) has triggered intense interest in better understanding of the role of extra-cranial venous anomalies and developmental variants. So far, there is no established diagnostic imaging modality, non-invasive or invasive, that can serve as the “gold standard” for detection of these venous anomalies. However, consensus guidelines and standardized imaging protocols are emerging. Most likely, a multimodal imaging approach will ultimately be the most comprehensive means for screening, diagnostic and monitoring purposes. Further research is needed to determine the spectrum of extra-cranial venous pathology and to compare the imaging findings with pathological examinations. The ability to define and reliably detect noninvasively these anomalies is an essential step toward establishing their incidence and prevalence. The role for these anomalies in causing significant hemodynamic consequences for the intra-cranial venous drainage in MS patients and other neurologic disorders, and in aging, remains unproven.

show abstract

Section: Noninvasive Imaging Modalitiesmentioning

confidence: 62%

The role of noninvasive and invasive diagnostic imaging techniques for detection of extra-cranial venous system anomalies and developmental variants

Dolić

Siddiqui

Karmon

et al. 2013

BMC Med

View full text Add to dashboard Cite

show abstract

“…Such lesions may be correlated with restricted outflow, which may caused by structural disturbances present in MS veins Coen et al, [66]. These structural alterations may involve switching from collagen type I to type III, which may provoke other structural abnormalities, including valve disturbances, which might alter venous hemodynamics [49]. This type of matrix remodeling might be adaptive in acute venous congestion to limit hemorrhages and iron deposition; such changes in matrix thickness or composition in ‘mature’ lesions could limit exchange or perfusion.…”

Section: Introductionmentioning

confidence: 99%

Venous endothelial injury in central nervous system diseases

Alexander

Prouty

Tsunoda

et al. 2013

BMC Med

View full text Add to dashboard Cite

The role of the venous system in the pathogenesis of inflammatory neurological/neurodegenerative diseases remains largely unknown and underinvestigated. Aside from cerebral venous infarcts, thromboembolic events, and cerebrovascular bleeding, several inflammatory central nervous system (CNS) diseases, such as multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), and optic neuritis, appear to be associated with venous vascular dysfunction, and the neuropathologic hallmark of these diseases is a perivenous, rather than arterial, lesion. Such findings raise fundamental questions about the nature of these diseases, such as the reasons why their pathognomonic lesions do not develop around the arteries and what exactly are the roles of cerebral venous inflammation in their pathogenesis. Apart from this inflammatory-based view, a new hypothesis with more focus on the hemodynamic features of the cerebral and extracerebral venous system suggests that MS pathophysiology might be associated with the venous system that drains the CNS. Such a hypothesis, if proven correct, opens new therapeutic windows in MS and other neuroinflammatory diseases. Here, we present a comprehensive review of the pathophysiology of MS, ADEM, pseudotumor cerebri, and optic neuritis, with an emphasis on the roles of venous vascular system programming and dysfunction in their pathogenesis. We consider the fundamental differences between arterial and venous endothelium, their dissimilar responses to inflammation, and the potential theoretical contributions of venous insufficiency in the pathogenesis of neurovascular diseases.

show abstract

“…This may have a great impact toward a deeper understanding of pathological disorders involving abnormalities of the cerebral venous outflow. In perspective, it may be used to assess which alterations in the extracranial venous outflow may be in relation with central nervous system disorders and aging (6,10,24,40,42).…”

mentioning

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

View full text Add to dashboard Cite

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...

show abstract

Morphological and haemodynamic abnormalities in the jugular veins of patients with multiple sclerosis

Abstract: In our group of patients, patients suffering from MS had significantly more IJV morphological changes and haemodynamic abnormalities when compared with healthy individuals not suffering from MS. These findings can be well demonstrated by non-invasive and cost-effective Doppler ultrasound.

Cited by 25 publications

References 14 publications

The role of noninvasive and invasive diagnostic imaging techniques for detection of extra-cranial venous system anomalies and developmental variants

The role of noninvasive and invasive diagnostic imaging techniques for detection of extra-cranial venous system anomalies and developmental variants

Venous endothelial injury in central nervous system diseases

A new hemodynamic model for the study of cerebral venous outflow

Contact Info

Product

Resources

About