Open Access Highly Accessed Research article

Chronic cerebrospinal venous insufficiency in multiple sclerosis: clinical correlates from a multicentre study

Stefano Bastianello1*, Alfredo Romani2, Gisela Viselner1, Enrico Colli Tibaldi1, Elisabetta Giugni3, Marta Altieri3, Pietro Cecconi4, Laura Mendozzi4, Massimiliano Farina5, Donatella Mariani5, Antonio Galassi6, Claudio Quattrini6, Marcello Mancini7, Vincenzo Bresciamorra7, Angela Lagace8, Sandy McDonald8, Giorgio Bono9 and Roberto Bergamaschi2

Author affiliations

1 Department of Public Health and Neurosciences, IRCCS "C. Mondino National Institute of Neurology" Foundation, University of Pavia, Italy

2 Interdepartmental Research Centre on Multiple Sclerosis, "C. Mondino National Institute of Neurology" Foundation, Pavia Italy

3 Department of Neurology and Psychiatry and Department of Neurosciences, Sapienza University of Rome, Italy

4 Multiple Sclerosis Centre, IRCCS Don Gnocchi, Milan, Italy

5 CCSVI Project, "Policlinico di Monza", University of Milan, Italy

6 Hospital of Civitanova, Marche, Italy

7 Department of Neurosciences Federico II, University of Naples, Italy

8 Barrie Vascular Imaging, Barrie Ontario, Canada

9 Department of Neurosciences, Ospedale Circolo, University of Varese, Italy

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Citation and License

BMC Neurology 2011, 11:132  doi:10.1186/1471-2377-11-132

Published: 26 October 2011



Chronic cerebrospinal venous insufficiency (CCSVI) has recently been reported to be associated with multiple sclerosis (MS). However, its actual prevalence, possible association with specific MS phenotypes, and potential pathophysiological role are debated.


We analysed the clinical data of 710 MS patients attending six centres (five Italian and one Canadian). All were submitted to venous Doppler sonography and diagnosed as having or not having CCSVI according to the criteria of Zamboni et al.


Overall, CCSVI was diagnosed in 86% of the patients, but the frequency varied greatly between the centres. Even greater differences were found when considering singly the five diagnostic criteria proposed by Zamboni et al. Despite these differences, significant associations with clinical data were found, the most striking being age at disease onset (about five years greater in CCSVI-positive patients) and clinical severity (mean EDSS score about one point higher in CCSVI-positive patients). Patients with progressive MS were more likely to have CCSVI than those with relapsing-remitting MS.


The methods for diagnosing CCSVI need to be refined, as the between-centre differences, particularly in single criteria, were excessively high. Despite these discrepancies, the strong associations between CCSVI and MS phenotype suggest that the presence of CCSVI may favour a later development of MS in patients with a lower susceptibility to autoimmune diseases and may increase its severity.