• Fiona Costello, Jayesh Modi, David Lautner, Deepak Bhayana, James N Scott, W Jeptha Davenport, Jessie Trufyn, Richard Frayne, Viesha A Ciura, Mayank Goyal, Jean Mah, and Michael D Hill.
• Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta. Vonacostello@rogers.com.
• CMAJ. 2014 Aug 5;186(11):E418-26.

BackgroundThe chronic cerebrospinal venous insufficiency theory proposes that altered cerebral venous hemodynamics play a role in the pathophysiology of multiple sclerosis. We aimed to explore the validity of this hypothesis by assessing the diagnostic criteria for chronic cerebrospinal venous insufficiency in persons with and without multiple sclerosis.MethodsWe compared the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls using extracranial Doppler ultrasonography and gadolinium-enhanced magnetic resonance venography. Interpreting radiologists were blinded to the clinical status of participants.ResultsWe enrolled 120 patients with multiple sclerosis and 60 healthy controls. High proportions of both patients (67/115 [58%]) and controls (38/60 [63%]) met 1 or more of the proposed ultrasound criteria for diagnosis of chronic cerebrospinal venous insufficiency (p = 0.6). A minority of patients (23/115 [20%]) and controls (6/60 [10%]) fulfilled 2 or more of the proposed criteria (p = 0.1). There were no differences between patients and controls in the prevalence of each individual ultrasound criterion. Similarly, there were no differences in intracranial or extracranial venous patency between groups, as measured by magnetic resonance venography.InterpretationWe detected no differences in the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls. Moreover, our study revealed significant methodologic concerns regarding the proposed diagnostic criteria for chronic cerebrospinal venous insufficiency that challenge their validity.© 2014 Canadian Medical Association or its licensors.

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