Hydration status substantially affects chronic cerebrospinal venous insufficiency assessments
Claudiu I Diaconu1, Robert J Fox, Alia Grattan
1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (CID), Mellen Center for Multiple Sclerosis Treatment and Research (RJF, AR-G), Heart and Vascular Institute, Cardiovascular Medicine, Non-Invasive Vascular Laboratory (AG, HLG, ESHK), and Neurological Institute, Cerebrovascular Center (ML), Cleveland Clinic, Cleveland, OH.
Neurology. Clinical Practice
|November 1, 2013
Summary
Hydration significantly impacts chronic cerebrospinal venous insufficiency (CCSVI) criteria in multiple sclerosis (MS) patients. Many individuals meeting CCSVI criteria when dehydrated no longer do so after rehydration, suggesting a physiological basis.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Imaging
Background:
- Chronic cerebrospinal venous insufficiency (CCSVI) is a debated hypothesis for the cause of multiple sclerosis (MS).
- Ultrasound criteria for CCSVI diagnosis are not standardized and may be influenced by physiological factors.
- The impact of hydration status on CCSVI diagnostic criteria requires further investigation.
Purpose of the Study:
- To investigate the effect of controlled hydration on the sonographic criteria for CCSVI.
- To determine if CCSVI findings in multiple sclerosis patients are influenced by hydration status.
- To assess whether CCSVI represents a physiological or pathological state.
Main Methods:
- A cohort of 16 subjects (11 with MS, 5 controls) underwent overnight fasting.
- Two CCSVI ultrasound examinations were performed: one in a dehydrated state and another after rehydration with 1.5 L of fluid.
- Participants were assessed for CCSVI criteria based on established sonographic markers.
Main Results:
- Seven subjects met CCSVI criteria while dehydrated.
- Following rehydration, 5 of these 7 subjects (71%) no longer met the CCSVI criteria.
- One subject met CCSVI criteria exclusively after rehydration.
Conclusions:
- Hydration status significantly influences the sonographic assessment of CCSVI.
- The sonographic findings suggestive of CCSVI may reflect transient physiological changes rather than a chronic pathological condition.
- These findings challenge the current diagnostic criteria for CCSVI and its proposed role in MS etiology.
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