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Chronic cerebrospinal venous insufficiency and susceptibility to multiple sclerosis.

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Chronic Cerebrospinal Venous Insufficiency and
Susceptibility to Multiple Sclerosis
Baracchini C, Perini P, Calabrese M, et al. No evidence of chronic
cerebrospinal venous insufficiency at multiple sclerosis onset. Ann
Neurol 2011;69:90–99.
Zamboni P, Galeotti R, Menegatti E, et al. Chronic cerebrospinal
venous insufficiency in patients with multiple sclerosis. J Neurol
Neurosurg Psychiatry 2009;80:392–399.
Zivadinov R, Marr K, Cutter G, et al. Prevalence, sensitivity and
specificity of chronic cerebrospinal venous insufficiency in multiple
sclerosis. Neurology (WNL.0b013e318212a901; published ahead
of print April 13, 2011).
Avruscio Giampiero, MD
I read carefully the article published in the January 2011 issue of
Annals of Neurology by Baracchini and colleagues on the prevalence of chronic cerebrospinal venous insufficiency (CCSVI)
measured with echo color Doppler sonography in patients with
high suspicion of initial multiple sclerosis (MS).1 These authors
give us 2 very important data that appear underestimated in their
report, but are of extreme importance in the scientific debate in
progress. In Table 4, they show positive CCSVI Doppler screening in 2% of controls matched for age and gender versus 16% of
patients with possible MS. This means that:
• The prevalence of CCSVI in healthy people is 2%, confirming Zamboni’s data,2 with rates far removed from the 22%
recently reported by Zivadinov et al.3
• The risk of having possible MS is dramatically increased by
the presence of CCSVI by >9-fold (odds ratio, 9.3; 95%
confidence interval, 1.1–78; p ¼ 0.0180).
In contrast to the conclusions of the authors, careful analysis of their results indicates that CCSVI may be among the factors
contributing to the development of MS symptoms at onset.
Potential Conflicts of Interest
Nothing to report.
Department of Vascular Medicine, Sant’Antonio Hospital,
Padua, Italy
DOI: 10.1002/ana.22451
Claudio Baracchini, MD,1 Paola Perini, MD,1,2
Francesco Causin, MD,3 Massimiliano Calabrese, MD,1,2
Francesca Rinaldi, MD,1,2 and Paolo Gallo, MD, PhD1,2
We thank Dr Avruscio for the opportunity he gives us to further
clarify some issues of our work.1 He recognizes as extremely important the data of our research; yet, he affirms that we have
underestimated its relevance, namely the presence of chronic cerebrospinal venous insufficiency (CCSVI), in 2% of the control
groups and an increased risk of having possible multiple sclerosis
(pMS) in CCSVI-positive subjects, thus supporting Zamboni’s
hypothesis.2 In our opinion, we neither underestimated the
results nor the significance of our work.
The aim of our study was to demonstrate an abnormal
cerebrospinal venous drainage in MS at onset. The first step
was to strictly apply Zamboni’s criteria for CCSVI. As shown
in our Table 4,1 transcranial ultrasound investigations never
detected any venous anomaly in pMS and healthy controls
(HC), while extracranial venous ultrasound disclosed a CCSVI
pattern in 8 of 50 (16%) pMS and 0 of 50 (0%) age-matched
FIGURE: Venographic examination of internal jugular vein stenoses (arrow) in non-MS patients with: (A) Cushing’s disease; (B)
craniopharyngioma; and (C) ‘‘delayed’’ progressive radiation myelopathy.
July 2011
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venous, insufficiency, sclerosis, multiple, susceptibility, chronic, cerebrospinal
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