Age-related Vascular Differences among Patients Suffering from Multiple Sclerosis
Francesco Ciciarello, Sandro Mandolesi, Aldo Innocente Galeandro, Azzurra Marceca, Michele Rossi, Francesco Fedele, Michele Gesualdo, Francesca Cortese, Annapaola Zito, Francesco Federico, Paolo Livrea, Maria Trojano, Pietro Scicchitano and Marco Matteo Ciccone
Affiliation: Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, piazza G. Cesare, 11, 70124 - Bari, Italy.
Keywords: Age, Disease duration, Echo-Doppler, Multiple sclerosis, Veins morphology/functions.
The aim of our study was to analyze morphological and functional aspects of cerebral veins by means of ecocolor-
Doppler in young (i.e., ≤30 years old) and older (i.e., >30 years old) patients suffering from multiple sclerosis. 552
multiple sclerosis patients were evaluated by means of a dedicated Echo-Color-Doppler support (MyLab Vinco echocolor
Doppler System, Esaote), in both supine and sitting positions. 458 (83%) showed alterations in their morphological
and functional structures of cerebral veins and were divided in two different groups: 1) ≤30 (110 patients) and 2) >30
years old (348 patients). Young patients showed a statistically significant higher number of both hemodynamically (44%
vs. 35%, p<0.01) and non-hemodynamically (51% vs. 45%, p<0.05) significant stenosis in the internal jugular veins as
compared to older patients. A lower percentage of young patients showed blocked outflow in the cervical veins (50% vs.
65%, p<0.01) as compared to older ones. Patients >30 years old outlined a significantly higher disability degree
(Expanded Disability Status Scale score: 5 vs. 3, p<0.01) as well as higher disease duration (12 vs. 5 months, p<0.01) than
younger. No differences could be outlined about multiple sclerosis clinical form of the disease. It was evidenced that
young and adult groups are different kind of patients, the former showing much more cerebral veins stenosis and blocked
flow in internal jugular veins and vertebral veins than the latter. Duration of disease could explain such differences: the
higher the diseases duration, the higher the degree of vascular alterations and, therefore, the disability degree. This could
be due to the complex venous hemodynamic impairments induced by alterations in vascular walls: the blocked or difficult
blood flow through stenosis could increase the hydrostatic pressure in the skull and this could induce damages to cerebral
cells leading to the genesis of more advanced morphological abnormalities. Furthermore, the vessels’ alterations could
impair venous endothelial functions which could turn in a possible alteration of the controls of cerebral vein return which
could worsen the cerebral vascular outflow. It may be possible that early clinical, pharmacological and/or invasive
vascular interventions could exert a possible role in the natural history of multiple sclerosis. Nevertheless, further trials are
needed in order to confirm such considerations.
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