Abstract
ObjectivesConstricted cerebral venous outflow has been linked with increased cerebrospinal fluid (CSF) pulsatility in the aqueduct of Sylvius in multiple sclerosis (MS) patients and healthy individuals. This study investigates the relationship between CSF pulsatility and internal jugular vein (IJV) cross-sectional area (CSA) in these two groups, something previously unknown.Methods65 relapsing-remitting MS patients (50.8% female; mean age = 43.8 years) and 74 healthy controls (HCs) (54.1% female; mean age = 43.9 years) were investigated. CSF flow quantification was performed on cine phase-contrast MRI, while IJV-CSA was calculated using magnetic resonance venography. Statistical analysis involved correlation, and partial least squares correlation analysis (PLSCA).ResultsPLSCA revealed a significant difference (p<0.001; effect size = 1.072) between MS patients and HCs in the positive relationship between CSF pulsatility and IJV-CSA at C5-T1, something not detected at C2-C4. Controlling for age and cardiovascular risk factors, statistical trends were identified in HCs between: increased net positive CSF flow (NPF) and increased IJV-CSA at C5-C6 (left: r = 0.374, p = 0.016; right: r = 0.364, p = 0.019) and C4 (left: r = 0.361, p = 0.020); and increased net negative CSF flow and increased left IJV-CSA at C5-C6 (r = -0.348, p = 0.026) and C4 (r = -0.324, p = 0.039), whereas in MS patients a trend was only identified between increased NPF and increased left IJV-CSA at C5-C6 (r = 0.351, p = 0.021). Overall, correlations were weaker in MS patients (p = 0.015).ConclusionsIn healthy adults, increased CSF pulsatility is associated with increased IJV-CSA in the lower cervix (independent of age and cardiovascular risk factors), suggesting a biomechanical link between the two. This relationship is altered in MS patients.
Highlights
Many studies have linked constriction of the internal jugular veins (IJVs) with retention of venous blood in the cranium [1] and increased intracranial pressure (ICP) [2,3,4,5]
partial least squares correlation analysis (PLSCA) revealed a significant difference (p
Controlling for age and cardiovascular risk factors, statistical trends were identified in HCs between: increased net positive CSF flow (NPF) and increased IJV-CSA at C5-C6 and C4; and increased net negative CSF flow and increased left IJV-CSA at C5-C6 (r = -0.348, p = 0.026) and C4 (r = -0.324, p = 0.039), whereas in MS patients a PLOS ONE | DOI:10.1371/journal.pone
Summary
Many studies have linked constriction of the internal jugular veins (IJVs) with retention of venous blood in the cranium [1] and increased intracranial pressure (ICP) [2,3,4,5]. Constriction of the IJVs has been shown to stiffen the brain parenchyma [6] and an increase in the amplitude of the cerebrospinal fluid (CSF) pulse in the aqueduct of Sylvius (AoS) [6, 7] in healthy individuals These findings indicate that cervical venous drainage plays an important role in regulating both ICP [8] and intracranial fluid dynamics [9, 10]. In order to establish whether or not MS patients behave differently from healthy individuals regarding this issue, we undertook a study involving 65 relapsing-remitting MS patients and 74 healthy controls, to investigate the relationship between IJV cross-sectional area (CSA) and the dynamics of the aqueductal CSF pulse in both groups
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