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AJNR Am J Neuroradiol. 2013 Jul;34(7):1370-4. doi: 10.3174/ajnr.A3390. Epub 2013 Jan 31.

Mystery of chronic cerebrospinal venous insufficiency: identical venographic and ultrasound findings in patients with MS and controls.

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Neurological Intervention and Imaging Service of Western Australia, Australian Neuromuscular Research Institute, Sir Charles Gairdner Hospital, Nedlands, Perth, Australia.



Stenosis of the internal jugular, azygos, and other veins detected by using intracranial and neck Doppler and B-mode sonography and confirmed by venography has been reported in MS with a high degree of sensitivity. This article reports the results of sonographic findings in patients with MS and controls, looking for evidence of the controversial entity chronic cerebrospinal venous insufficiency. Furthermore, the venographic appearance in controls is documented.


Thirty consecutive patients with definite MS and 10 controls had TCD and high-resolution Doppler sonography of the neck vessels by using the published sonography criteria of Zamboni et al. Those with 2 positive findings consented to undergo contrast digital subtraction venography for delineation of possible venous stenosis. Nine consecutive patients undergoing digital subtraction venography for petrosal venous sampling or parathormone sampling had images of their internal jugular veins obtained as part of their procedure, and they were assessed for stenosis.


No patient with MS or control had 2 positive sonographic findings; therefore, none were subjected to venography. Of the 9 controls undergoing venography for other reasons, 6 had bilateral IJV narrowing of ≥50%, and 2 others had unilateral narrowing.


No difference was detected between patients with MS and controls by using the objective sonographic criteria of Zamboni et al. Furthermore, normal physiologic narrowing is found very commonly in the internal jugular veins in healthy individuals. Nonblinded subjective sonographic assessment of the IJV may erroneously lead to venography, the findings of which may be misinterpreted due to the lack of widespread knowledge about the appearance of these veins in healthy individuals.

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