Influence of chronic cerebrospinal venous insufficiency on demyelinating diseases

We analyzed all the arguments against chronic cerebrospinal venous insufficiency (CCSVI) as a medical entity, and its association with a disabling demyelinating disease, multiple sclerosis (MS). We revised all the findings suggesting a possible connection between these two entities. By comparing the results obtained by different study groups, we noted a great variability in prevalence of CCSVI in MS patients, ranging from 0 to 100%. Overall the reported prevalence is respectively 70% in MS vs. 10% in controls, and a recent meta-analysis assessed an over 13 times increased prevalence in MS. Postmortem studies show a higher prevalence of intraluminal defects in the main cerebral extracranial vein in MS patients respect to controls. Several pathophysiological studies demonstrate correlation between CCSVI and neglected vascular aspects of MS. Particularly, global hypo-perfusion of the brain, as well as reduced cerebral spinal fluid dynamics inMS was shown to be related to CCSVI. After careful review of all obtained data we can conclude that great variability in prevalence of CCSVI in MS patients can be a result of different methodologies used in vein assessment, training, application of unapproved diagnostic criteria, or different approach to the problem itself. By many studies it has been shown that CCSVI can be inserted in the list of multiple factors involved in pathogenesis ofMS, aswell as other neurodegenerative diseases