Title:High Resolution M-mode Evaluation of Jugular Vein Valves in Patients with Neurological and Neurosensory Disorders
VOLUME: 14 ISSUE: 4
Author(s):Erica Menegatti*, Mirko Tessari, Maria Elena Vannini, Sergio Gianesini, Anna Maria Malagoni, Andrea Ciorba, Manuela Mazzoli, Francesco Sisini, Fabrizio Salvi, Stefano Pelucchi and Paolo Zamboni
Affiliation:Vascular Diseases Center, University of Ferrara, Ferrara, Vascular Diseases Center, University of Ferrara, Ferrara, Vascular Diseases Center, University of Ferrara, Ferrara, Vascular Diseases Center, University of Ferrara, Ferrara, Vascular Diseases Center, University of Ferrara, Ferrara, Department of Biomedical Sciences and Specialty Surgery, Section of Otorinolaringology, University of Ferrara, Ferrara, Department of Biomedical Sciences and Specialty Surgery, Section of Otorinolaringology, University of Ferrara, Ferrara, Vascular Diseases Center, University of Ferrara, Ferrara, Center for Diagnosis and Cure of Rare Diseases, IRCCS Institute of Neurological Sciences, Bologna, Department of Biomedical Sciences and Specialty Surgery, Section of Otorinolaringology, University of Ferrara, Ferrara, Vascular Diseases Center, University of Ferrara, Ferrara
Keywords:Cerebral venous drainage, duplex ultrasound, m-mode, internal jugular vein valves, chronic cerebrospinal venous
insufficiency, echo colour doppler.
Abstract:Background: High prevalence of valve absence was found in the internal jugular vein
(IJV) of healthy volunteers by means of M-mode high-resolution Echo Colour Doppler (ECD).
However, the prevalence of valve in neurovascular disorders linked to Chronic Cerebrospinal
Venous Insufficiency (CCSVI) is still unknown.
Methods: A cohort of 83 Healthy Controls (HC), 71 Multiple Sclerosis (MS), 99 Inner Ear Disorders
(IED) underwent ECD investigation of the IJV valve, including M-mode evaluation and related
hemodynamics. The primary outcome measure was characterization of valve presence, morphology
and motility, whereas the secondary outcome was the rate of flow alteration.
Results: Bilateral valve presence was found in 38% of HC, 58% of MS and 25% of IED, whereas,
bilateral valve absence was recorded in 16% of HC, 10% of MS and 31% of IED (p<0.003). Bicuspid
morphology was more prevalent in HC 56%, while monocusp was more prevalent in patients:
75% MS and 57% IED (p<0.0001). The main finding was the presence of mobile valve leaflets
in 98% of HC, contrarily fixed valve leaflets were recorded in 82% of MS and in 41% of IED,
p< 0.0001.
Finally, by stratifying the entire cohort according to the presence of mobile and not mobile valve
leaflets, normal monodirectional and phasic flow were commonly found in the mobile leaflets
subgroup, p<0.0001.
Conclusion: In patients with miscellaneous neurological disorders, a significant higher rate of defective
valves was found with respect to HC. The latter condition is strongly associated to brain
outflow abnormalities described in CCSVI condition.
