Abstract
BackgroundThe role of intra- and extra-cranial venous system impairment in the pathogenesis of various vascular, inflammatory and neurodegenerative neurological disorders, as well as in aging, has not been studied in detail. Nor have risk factors been determined for increased susceptibility of venous pathology in the intra-cranial and extra-cranial veins. The aim of this study was to investigate the association between presence of a newly proposed vascular condition called chronic cerebrospinal venous insufficiency (CCSVI) and environmental factors in a large volunteer control group without known central nervous system pathology.Methods and FindingsThe data were collected in a prospective study from 252 subjects who were screened for medical history as part of the entry criteria and participated in the case-control study of CCSVI prevalence in multiple sclerosis (MS) patients, and then were analyzed post-hoc. All participants underwent physical and Doppler sonography examinations, and were assessed with a structured environmental questionnaire. Fullfilment of ≥2 positive venous hemodynamic (VH) criteria on Doppler sonography was considered indicative of CCSVI diagnosis. Risk and protective factors associated with CCSVI were analyzed using logistic regression analysis. Seventy (27.8%) subjects presented with CCSVI diagnosis and 153 (60.7%) presented with one or more VH criteria. The presence of heart disease (p = .001), especially heart murmurs (p = .007), a history of infectious mononucleosis (p = .002), and irritable bowel syndrome (p = .005) were associated with more frequent CCSVI diagnosis. Current or previous smoking (p = .029) showed a trend for association with more frequent CCSVI diagnosis, while use of dietary supplements (p = .018) showed a trend for association with less frequent CCSVI diagnosis.ConclusionsRisk factors for CCSVI differ from established risk factors for peripheral venous diseases. Vascular, infectious and inflammatory factors were associated with higher CCSVI frequency.
Highlights
Several studies have shown a relationship between internal jugular vein (IJV) drainage abnormalities and specific neurological diseases of undetermined etiology such as transient global amnesia [1], transient monocular blindness [2], cough headache [3], primary exertional headache [4], idiopathic intra-cranial hypertension [5] and higher prevalence of white matter hyperintensities in elderly people.[6]
Risk factors for chronic cerebrospinal venous insufficiency (CCSVI) differ from established risk factors for peripheral venous diseases
Infectious and inflammatory factors were associated with higher CCSVI frequency
Summary
Several studies have shown a relationship between internal jugular vein (IJV) drainage abnormalities and specific neurological diseases of undetermined etiology such as transient global amnesia [1], transient monocular blindness [2], cough headache [3], primary exertional headache [4], idiopathic intra-cranial hypertension [5] and higher prevalence of white matter hyperintensities in elderly people.[6]. A new vascular condition called chronic cerebrospinal venous insufficiency (CCSVI) was proposed in patients with multiple sclerosis (MS) [7]. The role of intra- and extra-cranial venous system impairment in the pathogenesis of various vascular, inflammatory and neurodegenerative neurological disorders, as well as in aging, has not been studied in detail. The aim of this study was to investigate the association between presence of a newly proposed vascular condition called chronic cerebrospinal venous insufficiency (CCSVI) and environmental factors in a large volunteer control group without known central nervous system pathology
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