ISNVD Abstract Book

MONDAY – FEBRUARY 20, 2012 10:50am-11:10am
Venous and CSF flow in brain parenchyma of MS patients (Robert Zivadinov, USA)
The role of cerebrospinal fluid (CSF) dynamics in relation to multiple sclerosis (MS) clinical and MRI outcomes
has not been previously investigated. It could be hypothesized that impaired CSF flow dynamics may interplay
with the enlargement of the third, fourth and lateral ventricles, all of which are MRI signatures of central
atrophy in MS that appear from the earliest disease stages. The association of CSF dynamics and clinical
outcomes in MS is also unknown. The Monro-Kellie doctrine postulates that the sum of the brain, CSF, and
intracranial blood volumes must remain constant at all times throughout the cardiac cycle when the skull is
intact. Therefore, normal CSF circulation, in which homeostasis is maintained between ultra-filtration of CSF (in
the veins of the lateral ventricles) and clearance into the venous system at the level of the dural sinuses,
depends on efficient venous drainage. Chronic cerebrospinal venous insufficiency (CCSVI) is described as a
vascular condition characterized by anomalies of the main extra-cranial cerebrospinal venous routes that
possibly interferes with normal blood outflow of brain parenchyma. Any occlusion of the extra-cranial venous
pathways is likely to induce hypertension in the venous sinuses. Increased pressure in the superior sagittalsinus
(SSS) can inhibit the absorption of CSF through the arachnoid villi, decrease CSF brain parenchyma
drainage and induce hypoxic stress in the endothelia. Findings from our pilot study in 16 MS patients and 8
healthy subjects suggest that changes in the cerebral hydraulic regulatory mechanism may occur in patients
with MS. In that study, MS patients with CCSVI showed significantly lower net CSF flow which was highly
associated with the severity of CCSVI, compared to healthy controls. In a recent study, we investigated CSF
dynamics in the aqueduct of Sylvius in 67 MS patients, 9 patients with clinically isolated syndrome (CIS), and 35
age- and sex- matched healthy subjects on a 3T MRI using cine phase contrast imaging over 32 phases of the
cardiac cycle. It was found that CSF flow dynamic is altered in MS patients. More severe clinical and MRI
outcomes in relapsing MS and CIS patients are related to altered CSF flow and velocity measures.
Financial Disclosure: Teva Pharmaceuticals, Biogen Idec, EMD Serono, Genzyme, Bracco, Questcor, Greatbatch