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Open Access Highly Accessed Review

Venous hemodynamics in neurological disorders: an analytical review with hydrodynamic analysis

Clive B Beggs

Author affiliations

Medical Biophysics Laboratory, School of Engineering, Design and Technology, University of Bradford, Bradford, West Yorkshire BD7 1DP, UK

Citation and License

BMC Medicine 2013, 11:142  doi:10.1186/1741-7015-11-142

Published: 31 May 2013

Abstract

Venous abnormalities contribute to the pathophysiology of several neurological conditions. This paper reviews the literature regarding venous abnormalities in multiple sclerosis (MS), leukoaraiosis, and normal-pressure hydrocephalus (NPH). The review is supplemented with hydrodynamic analysis to assess the effects on cerebrospinal fluid (CSF) dynamics and cerebral blood flow (CBF) of venous hypertension in general, and chronic cerebrospinal venous insufficiency (CCSVI) in particular.

CCSVI-like venous anomalies seem unlikely to account for reduced CBF in patients with MS, thus other mechanisms must be at work, which increase the hydraulic resistance of the cerebral vascular bed in MS. Similarly, hydrodynamic changes appear to be responsible for reduced CBF in leukoaraiosis. The hydrodynamic properties of the periventricular veins make these vessels particularly vulnerable to ischemia and plaque formation.

Venous hypertension in the dural sinuses can alter intracranial compliance. Consequently, venous hypertension may change the CSF dynamics, affecting the intracranial windkessel mechanism. MS and NPH appear to share some similar characteristics, with both conditions exhibiting increased CSF pulsatility in the aqueduct of Sylvius.

CCSVI appears to be a real phenomenon associated with MS, which causes venous hypertension in the dural sinuses. However, the role of CCSVI in the pathophysiology of MS remains unclear.

Keywords:
Venous hypertension; CCSVI; Multiple sclerosis; Leukoaraiosis; Normal-pressure hydrocephalus; Cerebral blood flow; Cerebrospinal fluid