Assessment of chronic cerebrospinal venous insufficiency among Iraqi multiple sclerosis patients by Echo color Doppler sonography

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Hayder K. Hassoun¹, Riyadh W. Al Essawi¹, Taki Al Tiraihi², Nagham Al-Jussani¹, Zuhair Allebban³*

∗Correspondence author e-mail: zuhair.allabban@uokufa.edu.iq: ¹Middle Euphrates Neuroscience Center, College of medicine, University of Kufa, Iraq. ²Department of Pathology, Modares University, Tehran, Iran. 3Middle Euphrates Cancer Research Unit, College of medicine, University of Kufa, Iraq

Abstract

Multiple Sclerosis (MS) is a chronic inflammatory disease affecting central nervous system in dissemination fashion, time and place. Immune pathophysiology is considered as the main underlying cause of MS since its original description. Recently, scientists hypothesized that chronic cerebrospinal venous insufficiency (CCSVI) is a potential cause of MS sparked a controversial discussion in the scientific communities. The aim of this study is to test this hypothesis by high resolution Duplex color Doppler sonography among Iraqi MS patient. Randomized cross sectional blind controlled study conducted on 42 Iraqi participants (23 relapsing remitting MS patients and 19 healthy controls) whom fulfilled the inclusion and exclusion criteria. All study participants were examined blindly with color Doppler and pulse wave Doppler. Chronic cerebrospinal venous insufficiency is assessed blindly according to Zamboni sonography criteria by expert sonographist. The examination performed in supine and sitting position with 5 minutes rest to reach a steady state. General gray scale ultrasound with 6-10 MHz linear probe was used for both sides of the neck to assess the followings: internal jugular veins (IJV) obstruction, state of jugular valves, measurement of cross sectional area of proximal part of internal jugular veins, assessment of blood flow whether present or absent and measurement time of reverse flow in both internal jugular and vertebral veins (VVs) during Valsalva maneuver (VM). CCSVI is considered positive in the presence of 2 or more of the Zamboni sonography criteria. There was no significant differences in all parameters and criteria of CCSVI between healthy control and MS study groups. In conclusion; this study concluded that CCSVI has no significant contribution in the pathogenesis of MS.

Keywords: CCSVI; MS; Echo Doppler sonography and pathogenesis

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