Potential Involvement of Impaired Venous Outflow from the Brain in Neurodegeneration: Lessons Learned from the Research on Chronic Cerebrospinal Venous Insufficiency

2019 ◽  
Vol 14 (4) ◽  
pp. 235-236 ◽  
Author(s):  
Marian Simka ◽  
Marcin Skuła

About 10 years ago, the so-called chronic cerebrospinal venous insufficiency syndrome was discovered. This clinical entity, which is associated with extracranial venous abnormalities that impair venous outflow from the brain, was initially found exclusively in multiple sclerosis patients. Currently, we know that such venous lesions can also be revealed in other neurological pathologies, including Alzheimer’s and Parkinson’s diseases. Although direct causative role of chronic cerebrospinal venous insufficiency in these neurological diseases still remains elusive, in this paper, we suggest that perhaps an abnormal venous drainage of the brain affects functioning of the glymphatic system, which in turn results in the accumulation of pathological proteins in the cerebral tissue (such as β-synuclein, β-amyloid and α-synuclein) and triggers the venous outflow from the cranial cavity and circulation of the cerebrospinal fluid in the settings of neurodegenerative disease.

Author(s):  
Shelly Benjaminy ◽  
Anthony Traboulsee

The field of neuroethics aims to align neurotechnologies with societal values. To achieve this goal, the field must be responsive to the priorities of diverse publics. Researchers have developed many initiatives aimed at fostering reciprocal and inclusive dialogue between neuroscientists and publics that bring the voices of end-users to the forefront of innovation in the brain sciences. This chapter explores the opportunities and challenges of community engagement in the neurosciences. It draws on the contentious case study of the chronic cerebrospinal venous insufficiency (CCSVI) research trajectory that generated both hope and skepticism, galvanized substantial international attention, and was heavily criticized for privileging scientific inquiry driven more by public pressure than by evidence. It concludes with lessons learned from the cautionary CCSVI tale, and discusses opportunities for reciprocal and impactful engagement that the field of neuroethics may foster as novel neurotechnologies are developed.


2021 ◽  
Vol 17 (1) ◽  
pp. 42-49
Author(s):  
O.Ye. Kovalenko ◽  
N.G. Prityko

The article presents an analytical review of the results of domestic and foreign studies on chronic disorders of cerebral venous circulation, which is given less attention against the arterial system due to blurred manifestations, especially early, anatomical variability of the venous system, even in healthy, difficulty in diagnosis. When the balance of arterial and venous inflow is disturbed and this state exa­cerbates, irreversible changes evolve other structures of the cranial ca­vity — primarily in the brain (consistent with the concept of Monroe-Kelly). Chronic disorders of cerebral venous circulation may have different causes and varying degrees of severity. The equivalent of chronic cerebral venous insufficiency (SCVD), terminologically accepted in our country, in some countries is considered as chronic venous cerebrospinal insufficiency, which emphasizes the pathogenetic link of disorders of cerebral venous blood flow and extracranial veins, which is, in our opinion, is logical and reasonable. Recognition of chronic cerebrospinal venous insufficiency has aroused intense interest for a better understanding of the role of extracranial venous pathology and developmental options. Although the diagnosis was originally based on Doppler sonography, there are currently no diagnostic imaging methods, non-invasive or invasive, that can serve as the gold standard for detecting venous abnormalities indicative of chronic cerebrospinal venous insufficiency. The results of some studies are discussed, in particular, the hypothesis that chronic cerebrospinal venous insufficiency plays a role in the pathoge-nesis of multiple sclerosis or in many concomitant clinical manifestations. The affinity of the pathogenesis of idiopathic intracranial hypertension, Ménière’s disease, spondylotic vertebrobasilar insufficiency syndrome is analyzed. Attention is also focused on the other opinion of scientists when the increase in venous blood supply to the brain and other formations in the head cavity under certain conditions is considered as a compensatory reaction. The anatomical and physiological features of the venous system of the cranial cavity are considered, which substantiate the clinical manifestations of venous dysfunction, methods of diagnosis and treatment of pathology. Summarizing the above, chronic venous blood circulation in the cranial cavity, which is largely associated with problems of extracranial venous blood flow, not only in itself is a very characteristic syndrome complex t that adversely affects neurological functions due to cerebral hypoxia and metabolic changes, deteriorates the quality of life, but also has a negative impact on the course of the disease or has a pathogenetic link with other diseases, in particular, may be accompanied by different levels of blood pressure.


2013 ◽  
Vol 30 (1) ◽  
pp. 52-60 ◽  
Author(s):  
L Tromba ◽  
S Blasi ◽  
A Vestri ◽  
D Kiltzanidi ◽  
F Tartaglia ◽  
...  

Objectives: To verify the prevalence of chronic cerebrospinal venous insufficiency in patients affected by different clinical forms of multiple sclerosis and in healthy subjects using the Zamboni ultrasound protocol combined with M-mode ultrasound examination. Materials and methods: We enrolled 112 patients with multiple sclerosis and 67 healthy subjects from 20 to 67 years of age. All the patients underwent Duplex and color-Doppler sonography of the neck vessels, transcranial colour duplex sonography, M-mode study of the valve system and of venous abnormalities. Subjects were positive for chronic cerebrospinal venous insufficiency when at least two of five hemodynamic criteria of the Zamboni protocol were fulfilled. Chronic cerebrospinal venous insufficiency condition was further analyzed by a multivariate analysis including age, sex, disease duration, subtypes of multiple sclerosis and expanded disability status scale score as independent variables. Results: No healthy subjects was positive for chronic cerebrospinal venous insufficiency, while in the sample of patients affected by multiple sclerosis the diagnosis was made in 59.8% of cases ( p < 0.0001). The first criterion was the most frequent in patients affected by multiple sclerosis and chronic cerebrospinal venous insufficiency (respectively 54.4% and 76.1%, p < 0.001). The second, third and fourth criteria were never present in healthy subjects but were detected in patients with multiple sclerosis. The positivity of the second criterion was associated with diagnosis of chronic cerebrospinal venous insufficiency in 100% of cases. The third criterion had a prevalence of 52.2% in the subgroup of chronic cerebrospinal venous insufficiency patients. It was positive in 36 multiple sclerosis patients and was associated with chronic cerebrospinal venous insufficiency diagnosis in all cases except one. The multivariate analysis showed that age, disease duration, sex, subtypes of multiple sclerosis and expanded disability status scale score were not considered predictors of this haemodynamic condition. Conclusion: Chronic cerebrospinal venous insufficiency is a haemodynamic condition strongly associated with multiple sclerosis and is not found in normal controls. The addition of M-mode ultrasound to the diagnostic protocol allows improved observation of venous valve abnormalities.


2012 ◽  
Vol 18 (12) ◽  
pp. 1791-1796 ◽  
Author(s):  
MP Amato ◽  
V Saia ◽  
B Hakiki ◽  
M Giannini ◽  
L Pastò ◽  
...  

Objective: Chronic cerebrospinal venous insufficiency (CCSVI) was hypothesized to play a causative role in multiple sclerosis (MS). The assessment of pediatric-onset MS (POMS) may provide a unique window of opportunity to study hypothesized risk factors in close temporal association with the onset of the disease. Methods: Internal jugular veins, vertebral veins and intracranial veins were evaluated with extracranial and intracranial ultrasound in 15 POMS and 16 healthy controls. Assessor’s blinding was maintained during the study. We considered subjects positive to CCSVI when at least two criteria were fulfilled. Results: CCSVI frequency was comparable between POMS and controls ( p > 0.05). Clinical features were not significantly different between CCSVI-positive and CCSVI-negative patients. Conclusions: Our findings add to previous data pointing against a causative role of CCSVI in MS.


2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 107-113 ◽  
Author(s):  
P J Van Den Berg ◽  
L H Visser

A new venous disorder, chronic cerebrospinal venous insufficiency (CCSVI), has been proposed in patients with multiple sclerosis (MS). It is a vascular condition characterized by an impaired cerebrospinal venous drainage due to obstructions in the main extracranial cerebrovenous outflow routes (i.e. internal jugular veins [IJV] and/or azygos veins). In this review, the studies which assessed the prevalence of CCSVI in MS by echo colour Doppler (ECD) will be discussed. The technical aspects of determination of the five CCSVI criteria: (1) reflux in the IJV and/or vertebral veins in supine and upright position, (2) reflux in the deep cerebral veins, (3) high-resolution B-mode proximal IJV stenosis, (4) flow not Doppler detectable in IJVs and/or vertebral veins (VVs) and (5) reverted postural control of the main cerebrovenous outflow pathway are described in detail. We conclude that so far there are many studies with contradictory results, and as yet a strong scientific base to support the evidence for a causative relationship of CCSVI and MS is lacking. Recent studies call into question the validity of using ECD as a proper and reliable test for the diagnosis of CCSVI. One explanation for the variety in interpretation of the individual CCSVI criteria, with the wide-ranging percentages CCSVI, could be the different methods by using ECD to determine various criteria.


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