Open Access Highly Accessed Research article

Clinical correlates of chronic cerebrospinal venous insufficiency in multiple sclerosis

Bianca Weinstock-Guttman125*, Murali Ramanathan13, Karen Marr4, David Hojnacki1, Ralph HB Benedict1, Charity Morgan2, Eluen Ann Yeh1, Ellen Carl3, Cheryl Kennedy4, Justine Reuther4, Christina Brooks4, Kristin Hunt4, Makki Elfadil4, Michelle Andrews4 and Robert Zivadinov14

Author Affiliations

1 Department of Neurology, State University of New York, Buffalo, NY, USA

2 Department of Biostatistics, University of Alabama, Birmingham, AL, USA

3 Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY, USA

4 Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York, Buffalo, NY, USA

5 Department of Neurology, State University of New York, Buffalo, E2 Neurology, Buffalo General Hospital, 100 High Street, Buffalo, NY, 14203, USA

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BMC Neurology 2012, 12:26  doi:10.1186/1471-2377-12-26

Published: 15 May 2012



Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of the primary veins outside the skull that has been reported to be associated with MS. In the blinded Combined Transcranial (TCD) and Extracranial Venous Doppler Evaluation (CTEVD) study, we found that prevalence of CCSVI was significantly higher in multiple sclerosis (MS) vs. healthy controls (HC) (56.1% vs. 22.7%, p < 0.001).

The objective was to evaluate the clinical correlates of venous anomalies indicative of CCSVI in patients with MS.


The original study enrolled 499 subjects; 163 HC, 289 MS, 21 CIS and 26 subjects with other neurological disorders who underwent a clinical examination and a combined Doppler and TCD scan of the head and neck. This analysis was restricted to adult subjects with MS (RR-MS: n = 181, SP-MS: n = 80 and PP-MS: n = 12). Disability status was evaluated by using the Kurtzke Expanded Disability Status Scale (EDSS) and MS severity scale (MSSS).


Disability was not associated with the presence (≥2 venous hemodynamic criteria) or the severity of CCSVI, as measured with venous hemodynamic insufficiency severity score (VHISS). However, the severity of CCSVI was associated with the increased brainstem functional EDSS sub-score (p = 0.002). In logistic regression analysis, progressive MS (SP-MS or PP-MS) vs. non-progressive status (including RR-MS) was associated with CCSVI diagnosis (p = 0.004, OR = 2.34, CI = 1.3–4.2).


The presence and severity of CCVSI in multiple sclerosis correlate with disease status but has no or very limited association with clinical disability.

Multiple sclerosis; Disease progression; Disability; Echo-color Doppler; Venous anomalies; CCSVI