Study of the chronic cerebro-spinal venous insufficiency in a population of young people with multiple sclerosis by hemodynamic morphological map

Background:Multiple Sclerosis (MS),a autoimmune neurological disorder of young adults.Chronic Cerebro-Spinal Venous Insufficiency(CCSVI) is a new vascular pattern recently identified by Zamboni, who associated CCSVI with MS.The aim of our study is to analyze the presence of CCSVI in a young population ,30 years old affected by MS, following Zamboni five ultrasound criteria and using a Hæmodynamic Morphological Map (HMM) versus a large sample of patients with MS and age.30 years old. Materials and Methods: We included in this study 146 young patients (G1) with MS (all clinical types), age,30 years old and mean duration disease ,5 years (women 59,9%, n=86; men 41,1%, n=60; mean age 25 years; mean Expanded Disability Disease Score, EDSS 3). A control group was composed of 406(G2)MS patients,.30 years old,mean duration disease .5 years (women 60,8%, n=247; men 39,2%, n=159; mean age 47 years; mean EDSS 5). We used a protocol with EchoColorDoppler equipped with 2.5/7.5 Mhz probe,focusing on the detection of Zamboni five criteria:1-Reflux in the Internal Jugular Veins(IJVs) and/or Vertebral Veins (VVs);2-Reflux in the Internal cerebral veins(DCVs);3-High-resolution B-mode evidence of proximal IJV stenosis;4-Flow not Doppler detectable in the IJVs and/or VVs;5-Reverted postural control of the main cerebral venous outflow pathway, investigating in both positions (08and 908).The ECD examinations were then reported on HMM (a new digital computerized software, created in our school, where the operator inserts symbols that correspond to the five Zamboni criteria). Results: our data show a statistically significant of CCSVI within G1 and G2(G1:pos 75,5%, neg 24,5%;G2:pos 85,7%, G1 neg 14,3%) but the difference is not statistically significant between groups. In both G1 and in G2 samples, all the CCSVI criteria were uniformly distributed, in particular for the Criteria3 (IJV stenosis), although there was an evident and statistically significant for the Criteria4 (IJV block;G1:50% and G2:65% with p,0,01)and EDSS(G1 mean 3 and G2 mean 5 p,0,01). Conclusions: HMM enables us to see the presence of CCSVI, it simplifies the job of reporting to the operator and it facilitates statistical analysis of the CCSVI criteria. Furthermore we believe that the criteria4 is not only an intra-venous block but also a compression of a normal vein (IJVs and/or VVs). This vein with compression is not visible in the sitting and/or supine posture because empty, that expands with changes in the position of the neck or Valsalva manouver, which could be related to postural behaviour and the increased of EDSS.