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Ultrasonographic evaluation of cerebral arterial and venous haemodynamics in multiple sclerosis: a case-control study.

Marchione P, Morreale M, Giacomini P, Izzo C, Pontecorvo S, Altieri M, Bernardi S, Frontoni M, Francia A - PLoS ONE (2014)

Bottom Line: ΔCVF was negative in 45/85 (52.9%) RR-MS, 63/83 (75.9%) PP-MS (p = 0.01) and 11/82 (13.4%) controls (p<0.001), while MFVs on both MCAs in sitting position were significantly reduced in RR-MS and PP-MS patients than in control, particularly in EDSS ≥ 5 subgroup (respectively, 42/50, 84% vs. 66/131, 50.3%, p<0.01 and 48.3 ± 2 cm/s vs. 54.6 ± 3 cm/s, p = 0.01).No significant differences in CPP were observed within and between groups.It's not clear whether the altered postural control of arterial inflow and venous outflow is a specific MS condition or simply an "epiphenomenon" of neurodegenerative events.

View Article: PubMed Central - PubMed

Affiliation: Neurovascular Diagnosis Unit, Department of Medical and Surgical Sciences and Biotechnology - Section of Neurology, Sapienza, University of Rome, Rome, Italy; Department of Clinical Neurosciences, Neurological Centre of Latium - Institute of Neurosciences, Rome, Italy.

ABSTRACT

Objective: Although recent studies excluded an association between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis (MS), controversial results account for some cerebrovascular haemodynamic impairment suggesting a dysfunction of cerebral autoregulation mechanisms. The aim of this cross-sectional, case-control study is to evaluate cerebral arterial inflow and venous outflow by means of a non-invasive ultrasound procedure in Relapsing Remitting (RR), Primary Progressive (PP) Multiple Sclerosis and age and sex-matched controls subjects.

Material and methods: All subjects underwent a complete extra-intracranial arterial and venous ultrasound assessment with a color-coded duplex sonography scanner and a transcranial doppler equipment, in both supine and sitting position by means of a tilting chair. Basal arterial and venous morphology and flow velocities, postural changes in mean flow velocities (MFV) of middle cerebral arteries (MCA), differences between cerebral venous outflow (CVF) in clinostatism and in the seated position (ΔCVF) and non-invasive cerebral perfusion pressure (CPP) were evaluated.

Results: 85 RR-MS, 83 PP-MS and 82 healthy controls were included. ΔCVF was negative in 45/85 (52.9%) RR-MS, 63/83 (75.9%) PP-MS (p = 0.01) and 11/82 (13.4%) controls (p<0.001), while MFVs on both MCAs in sitting position were significantly reduced in RR-MS and PP-MS patients than in control, particularly in EDSS ≥ 5 subgroup (respectively, 42/50, 84% vs. 66/131, 50.3%, p<0.01 and 48.3 ± 2 cm/s vs. 54.6 ± 3 cm/s, p = 0.01). No significant differences in CPP were observed within and between groups.

Conclusions: The quantitative evaluation of cerebral blood flow (CBF) and CVF and their postural dependency may be related to a dysfunction of autonomic nervous system that seems to characterize more disabled MS patients. It's not clear whether the altered postural control of arterial inflow and venous outflow is a specific MS condition or simply an "epiphenomenon" of neurodegenerative events.

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Related in: MedlinePlus

Negative ΔCVF distribution between groups.
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pone-0111486-g001: Negative ΔCVF distribution between groups.

Mentions: A significant asymmetry of the venous CSA (>50%) in supine position were observed in 19 (22.3%) RR-MS, 17 (20.2%) PP-MS patients and 16 (19.5%) HCs with prevalent reduction of left IJV diameter. A negative ΔCSA value was observed in 3 (3.5%) RR-MS, 1 PP-MS (1.2%) and 3 (3.6%) controls. Mean global CBF and CVF values in clinostatism are showed in table 2. The slight reduction of both global CBF and mean total CVF resulted no statistically significant. ΔCVF was negative in 108/173 MS patients (62.4%) and 11/82 (13.4%) HCs (p<0.001). According to clinical phenotype, ΔCVF was negative in 45/85 (52.9%) RR-MS and 63/83 (75.9%) PP-MS (p = 0.01) (figure 1). Age and sex-related differences of CBF, CFV and ΔCVF were not statistically significant. There were no significant correlation among negative ΔCVF and significant asymmetry of venous CSA or negative ΔCSA value. A significantly higher prevalence of negative ΔCVF was observed in EDSS>5 subgroup (42/50, 84%) than in EDSS<5 subgroup (66/118, 55.9%) (p<0.01).


Ultrasonographic evaluation of cerebral arterial and venous haemodynamics in multiple sclerosis: a case-control study.

Marchione P, Morreale M, Giacomini P, Izzo C, Pontecorvo S, Altieri M, Bernardi S, Frontoni M, Francia A - PLoS ONE (2014)

Negative ΔCVF distribution between groups.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216015&req=5

pone-0111486-g001: Negative ΔCVF distribution between groups.
Mentions: A significant asymmetry of the venous CSA (>50%) in supine position were observed in 19 (22.3%) RR-MS, 17 (20.2%) PP-MS patients and 16 (19.5%) HCs with prevalent reduction of left IJV diameter. A negative ΔCSA value was observed in 3 (3.5%) RR-MS, 1 PP-MS (1.2%) and 3 (3.6%) controls. Mean global CBF and CVF values in clinostatism are showed in table 2. The slight reduction of both global CBF and mean total CVF resulted no statistically significant. ΔCVF was negative in 108/173 MS patients (62.4%) and 11/82 (13.4%) HCs (p<0.001). According to clinical phenotype, ΔCVF was negative in 45/85 (52.9%) RR-MS and 63/83 (75.9%) PP-MS (p = 0.01) (figure 1). Age and sex-related differences of CBF, CFV and ΔCVF were not statistically significant. There were no significant correlation among negative ΔCVF and significant asymmetry of venous CSA or negative ΔCSA value. A significantly higher prevalence of negative ΔCVF was observed in EDSS>5 subgroup (42/50, 84%) than in EDSS<5 subgroup (66/118, 55.9%) (p<0.01).

Bottom Line: ΔCVF was negative in 45/85 (52.9%) RR-MS, 63/83 (75.9%) PP-MS (p = 0.01) and 11/82 (13.4%) controls (p<0.001), while MFVs on both MCAs in sitting position were significantly reduced in RR-MS and PP-MS patients than in control, particularly in EDSS ≥ 5 subgroup (respectively, 42/50, 84% vs. 66/131, 50.3%, p<0.01 and 48.3 ± 2 cm/s vs. 54.6 ± 3 cm/s, p = 0.01).No significant differences in CPP were observed within and between groups.It's not clear whether the altered postural control of arterial inflow and venous outflow is a specific MS condition or simply an "epiphenomenon" of neurodegenerative events.

View Article: PubMed Central - PubMed

Affiliation: Neurovascular Diagnosis Unit, Department of Medical and Surgical Sciences and Biotechnology - Section of Neurology, Sapienza, University of Rome, Rome, Italy; Department of Clinical Neurosciences, Neurological Centre of Latium - Institute of Neurosciences, Rome, Italy.

ABSTRACT

Objective: Although recent studies excluded an association between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis (MS), controversial results account for some cerebrovascular haemodynamic impairment suggesting a dysfunction of cerebral autoregulation mechanisms. The aim of this cross-sectional, case-control study is to evaluate cerebral arterial inflow and venous outflow by means of a non-invasive ultrasound procedure in Relapsing Remitting (RR), Primary Progressive (PP) Multiple Sclerosis and age and sex-matched controls subjects.

Material and methods: All subjects underwent a complete extra-intracranial arterial and venous ultrasound assessment with a color-coded duplex sonography scanner and a transcranial doppler equipment, in both supine and sitting position by means of a tilting chair. Basal arterial and venous morphology and flow velocities, postural changes in mean flow velocities (MFV) of middle cerebral arteries (MCA), differences between cerebral venous outflow (CVF) in clinostatism and in the seated position (ΔCVF) and non-invasive cerebral perfusion pressure (CPP) were evaluated.

Results: 85 RR-MS, 83 PP-MS and 82 healthy controls were included. ΔCVF was negative in 45/85 (52.9%) RR-MS, 63/83 (75.9%) PP-MS (p = 0.01) and 11/82 (13.4%) controls (p<0.001), while MFVs on both MCAs in sitting position were significantly reduced in RR-MS and PP-MS patients than in control, particularly in EDSS ≥ 5 subgroup (respectively, 42/50, 84% vs. 66/131, 50.3%, p<0.01 and 48.3 ± 2 cm/s vs. 54.6 ± 3 cm/s, p = 0.01). No significant differences in CPP were observed within and between groups.

Conclusions: The quantitative evaluation of cerebral blood flow (CBF) and CVF and their postural dependency may be related to a dysfunction of autonomic nervous system that seems to characterize more disabled MS patients. It's not clear whether the altered postural control of arterial inflow and venous outflow is a specific MS condition or simply an "epiphenomenon" of neurodegenerative events.

Show MeSH
Related in: MedlinePlus