Open Access Highly Accessed Research article

Chronic cerebrospinal venous insufficiency in multiple sclerosis: a highly prevalent age-dependent phenomenon

Roberta Lanzillo15, Marcello Mancini23, Raffaele Liuzzi24*, Orlando Di Donato4, Elena Salvatore4, Valentina Maglio4, Giovanni Vacca4, Luca Amato1, Gennaro D’Anna4, Arturo Brunetti4 and Vincenzo Brescia Morra1

Author Affiliations

1 Department of Neurological Sciences, Federico II University School of Medicine, Naples, Italy

2 Institute of Biostructure and Bioimaging, National Research Council of Italy (CNR), Naples, Italy

3 IRCCS, SDN Foundation, Institute of Diagnostic and Nuclear development, Naples, Italy

4 Department of Biomorphological and Functional Science, Federico II University School of Medicine, Naples, Italy

5 Hermitage Capodimonte IDC, Naples, Italy

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BMC Neurology 2013, 13:20  doi:10.1186/1471-2377-13-20

Published: 13 February 2013



This study aimed to investigate the prevalence and clinical relevance of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS) patients and healthy controls using extra- and intracranial colour Doppler sonography.


We examined 146 MS patients, presenting with a clinically isolated syndrome, relapsing-remitting, secondary progressive, or primary progressive MS, and 38 healthy controls. Sonographic examination was performed according to Zamboni’s protocol and was performed by three independent sonographers. The results of sonographic examination were compared with clinical and demographic characteristics of the patients.


CCSVI, defined as the presence of at least two positive Zamboni’s criteria, was found in 76% of MS patients and 16% of control subjects. B-mode anomalies of internal jugular veins, such as stenosis, malformed valves, annuli, and septa were the most common lesions detected in MS patients (80.8%) and controls (47.4%). We observed a positive correlation between sonographic diagnosis of CCSVI and the patients’ age (p = 0.003). However, such a correlation was not found in controls (p = 0.635). Notably, no significant correlations were found between sonographic signs of CCSVI and clinical characteristics of MS, except for absent flow in the jugular veins, which was found more often in primary (p<0.005) and secondary (p<0.05) progressive patients compared with non-progressive patients. Absent flow in jugular veins was significantly correlated with patients’ age (p < 0.0001).


Sonographically defined CCSVI is common in MS patients. However, CCSVI appears to be primarily associated with the patient’s age, and poorly correlated with the clinical course of the disease.

Multiple sclerosis; Venous insufficiency; Ultrasonography