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Original Contributions |

No Cerebral or Cervical Venous Insufficiency in US Veterans With Multiple Sclerosis

Ellen Marder, MD; Pramod Gupta, MD; Benjamin M. Greenberg, MD; Elliot M. Frohman, MD, PhD; Amer M. Awad, MD; Bridget Bagert, MD; Olaf Stüve, MD, PhD
Arch Neurol. 2011;68(12):1521-1525. doi:10.1001/archneurol.2011.185.
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Objective To determine if chronic cerebral venous insufficiency exists in patients with multiple sclerosis (MS) using ultrasonography and 4-dimensional color Doppler ultrasonography examination and unverified criteria proposed by Zamboni et al.

Design Patients with MS and clinically isolated syndrome were matched by age and sex with subjects with migraine or no neurological disease. All subjects underwent gray-scale, color, and spectral Doppler ultrasonography examination of the internal jugular veins (IJVs), vertebral veins, and deep cerebral veins for stenosis, absence of signal, and reflux.

Setting Academic MS center.

Patients All patients with MS fulfilled revised McDonald criteria for the diagnosis of MS. Patients with clinically isolated syndrome exhibited a typical transient focal neurological deficit and had magnetic resonance imaging lesions typical of MS. Control subjects were recruited from the VA migraine clinic or staff.

Main Outcome Measures Five parameters of venous outflow used by Zamboni et al were examined: (1) IJV or vertebral vein reflux, (2) deep cerebral vein reflux, (3) IJV stenosis, (4) absence of flow in IJVs or vertebral veins, and (5) change in cross-sectional area of the IJV with postural change.

Results There was no significant difference in the number and type of venous outflow abnormalities in patients with MS compared with controls.

Conclusion This study does not support the theory that chronic cerebral venous insufficiency exists in MS.

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