Abstract
BackgroundIt has been suggested there is a chronic neurodegenerative disorder, underlying the pathophysiology of multiple sclerosis (MS), which is distinct from the more obvious immune-mediated attack on the white matter. Limited data exists indicating there is an alteration in pulse wave propagation within the craniospinal cavity in MS, similar to the findings in normal pressure hydrocephalus (NPH). It is hypothesized MS may harbor pulse wave encephalopathy. The purpose of this study is to compare blood flow and pulse wave measurements in MS patients with a cohort of NPH patients and control subjects, to test this hypothesis.MethodsTwenty patients with MS underwent magnetic resonance (MR) flow quantification techniques. Mean blood flow and stroke volume were measured in the arterial inflow and venous out flow from the sagittal (SSS) and straight sinus (ST). The arteriovenous delay (AVD) was defined. The results were compared with both age-matched controls and NPH patients.ResultsIn MS there was a 35 % reduction in arteriovenous delay and a 5 % reduction in the percentage of the arterial inflow returning via the sagittal sinus compared to age matched controls. There was an alteration in pulse wave propagation, with a 26 % increase in arterial stroke volume but 30 % reduction in SSS and ST stroke volume. The AVD and blood flow changes were in the same direction to those of NPH patients.ConclusionsThere are blood flow and pulsation propagation changes in MS patients which are similar to those of NPH patients. The findings would be consistent with an underlying pulse wave encephalopathy component in MS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12987-016-0041-2) contains supplementary material, which is available to authorized users.
Highlights
It has been suggested there is a chronic neurodegenerative disorder, underlying the pathophysiology of multiple sclerosis (MS), which is distinct from the more obvious immune-mediated attack on the white matter
There was no significant alteration in the percentage of the blood flow returned by each sinus compared to the arterial inflow
We note that the arteriovenous delay (AVD) does not change from the normal young to the normal elderly similar to a previous study [24] suggesting the compliance of the craniospinal system remains unchanged with normal aging. This is in comparison with the findings in normal pressure hydrocephalus (NPH), in which the present study shows a 58 % reduction in AVD compared to age matched controls
Summary
It has been suggested there is a chronic neurodegenerative disorder, underlying the pathophysiology of multiple sclerosis (MS), which is distinct from the more obvious immune-mediated attack on the white matter. Lim‐ ited data exists indicating there is an alteration in pulse wave propagation within the craniospinal cavity in MS, similar to the findings in normal pressure hydrocephalus (NPH). It is hypothesized MS may harbor pulse wave encephalopa‐ thy. Given that multiple sclerosis is characterized by simultaneous focal breakdown of the blood–brain barrier, the development of demyelinating lesions that are associated with immune-mediated inflammation and eventual axonal loss [3], it may be hard to discern which is the initiating event and which the secondary
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