Veins and Lymphatics 2014; volume 3:4195 [page 74] [Veins and Lymphatics 2014; 3:4195]

Last January The Lancet published the arti-cle by Traboulsee et al. Prevalence of extracra-nial venous narrowing on catheter venography in people with multiple sclerosis, their sibil-ings, and unrelated healthy controls: a blinded, case control study. These Authors confirmed the presence of chronic cerebrospinal venous insufficiency with a high prevalence of about 70 % in the Canadian population, but without significant differences between patients and healthy controls, yet. However, they used a cri-terion never published to assess stenosis, in alternative to the classic measurement of the diameter in the segment immediately preced-ing the narrowest point. Traboulsee et al. measure the stenosis along the entire length of the internal jugular vein, by comparing the maximum diameter with the narrowest point. It has been demonstrated, from normal anato-my findings, how the jugular bulb diameter normally exceeds 50 % of the minimum diame-ter of the internal jugular vein, clearly showing the reason why Traboulsee et al. did not find significant differences between people with multiple sclerosis, their sibilings, and unrelat-ed healthy controls. Furthermore, as the outcome measure of Traboulsee et al., wall stenosis is a neglected part of primary venous obstruction, because in the majority of cases obstruction is the conse-quence of intraluminal obstacles, as a consid-erable part of truncular venous malformations, and/or compression; rarely of external hypopla-sia. Finally, several recently published methods can be adopted for objective assessment of restricted jugular flow in course of chronic cerebrospinal venous insufficiency, by the means of non invasive magnetic resonance imaging, ultrasound and plethysmography. This may help us in improving the assess-ment of cerebral venous return in the near future