Modificazioni fisiopatologiche e cliniche indotte a livello del Sistema Nervoso Centrale dall'Insufficienza Venosa Cerebrospinale Cronica (CCSVI)

BACKGROUND – The description of a new syndrome, the Chronic Cerebrospinal Venous Insufficiency (CCSVI), led us to investigate the relationship between the venous system and Central Nervous System (CNS). In particular, in the last years we have focused on the relationship between CCSVI and Multiple Sclerosis (MS). OBJECTIVES - To evaluate the clinical and pathophysiological changes induced by CCSVI in the CNS, particularly how this syndrome causes iron deposition in the brain parenchyma, the alteration of MRI perfusion, the CSF outflow obstruction and the immune system activation that generates demyelinating lesions. MATERIALS AND METHODS - 102 MS patients (46 RR, 30 SP, 26 PP), and 30 subjects with CNS involvement non MS (15 affected by CIS, 7 people with evidence of RIS, 4 patients with Arnold- Chiari Syndrome and 4 with chronic headache) underwent a combined transcranial and extracranial EchoColorDoppler high-resolution examination (TCCS-ECD) aimed at detecting the prevalence of CCSVI and correlate the venous system involvement with the clinical findings. CCSVI is defined by the presence of at least two out of five parameters of anomalous venous outflow described by Zamboni. Finally we studied the possible correlations between the different hemodynamic patterns and the symptoms of the onset of MS and clinical course; we evaluated the long term clinical outcome of patients with relapsing-remitting MS after PTA treatment. RESULTS -According to the TCCS-ECD criteria, CCSVI is present in 97% of MS patients, in 73% of CIS, in 71% of RIS and even if the cohort is too small to be representative, in 100% of Arnold-Chiari and in 75% of headaches. CCSVI is a syndrome characterized by headache that appears or worse in supine position, sleep disorders, cognitive dysfunctions, chronic fatigue and memory disorders. In a few patients we found extrapyramidal syndrome and normal pressure hydrocephalus. CONCLUSION - MS is strongly associated with CCSVI; endovascular treatment is effective on neurological signs and symptoms of MS although multicenter, double-blind, clinical trial with a larger number of patients will be necessary to confirm this data. Venous neurovascular team is necessary to the care of patients with MS and for better understanding the pathogenesis of MS.