Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: A blinded, case-control study

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Abstract

Background Chronic cerebrospinal venous insuffi ciency has been proposed as a unique combination of extracranial venous blockages and haemodynamic flow abnormalities that occurs only in patients with multiple sclerosis and not in healthy people. Initial reports indicated that all patients with multiple sclerosis had chronic cerebrospinal venous insuffi ciency. We aimed to establish the prevalence of venous narrowing in people with multiple sclerosis, unaff ected full siblings, and unrelated healthy volunteers. Methods We did an assessor-blinded, case-control, multicentre study of people with multiple sclerosis, unaff ected siblings, and unrelated healthy volunteers. We enrolled the study participants between January, 2011 and March, 2012, and they comprised 177 adults: 79 with multiple sclerosis, 55 siblings, and 43 unrelated controls, from three centres in Canada. We assessed narrowing of the internal jugular and azygous veins with catheter venography and ultrasound criteria for chronic cerebrospinal venous insuffi ciency proposed by Zamboni and colleagues. Catheter venography data were available for 149 participants and ultrasound data for 171 participants. Findings Catheter venography criteria for chronic cerebrospinal venous insuffi ciency were positive for one of 65 (2%) people with multiple sclerosis, one of 46 (2%) siblings, and one of 32 (3%) unrelated controls (p=1.0 for all comparisons). Greater than 50% narrowing of any major vein was present in 48 of 65 (74%) people with multiple sclerosis, 31 of 47 (66%) siblings (p=0.41 for comparison with patients with multiple sclerosis), and 26 of 37 (70%) unrelated controls (p=0.82). The ultrasound criteria for chronic cerebrospinal venous insuffi ciency were fulfi lled in 35 of 79 (44%) participants with multiple sclerosis, 17 of 54 (31%) siblings (p=0.15 for comparison with patients with multiple sclerosis) and 17 of 38 (45%) unrelated controls (p=0.98). The sensitivity of the ultrasound criteria for detection of greater than 50% narrowing on catheter venography was 0.406 (95% CI 0.311-0.508), and specifi city was 0.643 (0.480-0.780). Interpretation This study shows that chronic cerebrospinal venous insuffi ciency occurs rarely in both patients with multiple sclerosis and in healthy people. Extracranial venous narrowing of greater than 50% is a frequent fi nding in patients with multiple sclerosis, unaff ected siblings, and unrelated controls. The ultrasound criteria are neither sensitive nor specifi c for narrowing on catheter venography. The signifi cance of venous narrowing to multiple sclerosis symptomatology remains unknown. Funding MS Society of Canada, Saskatoon City Hospital Foundation, Lotte and John Hecht Memorial Foundation, Vancouver Coastal Health Foundation, and the Wolridge Foundation.

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APA

Traboulsee, A. L., Knox, K. B., Machan, L., Zhao, Y., Yee, I., Rauscher, A., … Sadovnick, D. (2014). Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: A blinded, case-control study. The Lancet, 383(9912), 138–145. https://doi.org/10.1016/S0140-6736(13)61747-X

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