“The descriptive study below describes frequent asymmetries in the internal jugular veins (IJV) of non-MSers. It is a pity this was not compared to another control group, in particular a group of MSers. In my experience from looking at 1000’s of scans is that asymmetry in blood vessels, including arteries, veins and venous sinuses, is the norm. This is not surprising if you consider the embryonic development of the vasculature. They author’s also found a very high incidence of stenoses, which seems much higher than what one would expect. However, without comparative data it is hard to draw any conclusions from these observations. I wonder if anyone has looked at animals with chronic EAE, or other disease models, for similar findings or for that matter other inflammatory diseases of the CNS? Could this be linked to inflammation in the blood vessels? Or viral infection of the vasculature? Some herpes viruses have a predilection for blood vessels. These findings are non-specific to me and clearly change the way we should view similar findings in MSers.”
Torres et al. Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant? Neuro European Radiology pp 1-8, First online: 24 March 2016.
Objective: To evaluate the extracranial venous anatomy with contrast-enhanced MR venogram (CE-MRV) in patients without multiple sclerosis (MS), and assess the prevalence of various venous anomalies such as asymmetry and stenosis in this population.
Materials and methods: We prospectively recruited 100 patients without MS, aged 18–60 years, referred for contrast-enhanced MRI. They underwent additional CE-MRV from skull base to mediastinum on a 3T scanner. Exclusion criteria included prior neck radiation, neck surgery, neck/mediastinal masses or significant cardiac or pulmonary disease. Two neuroradiologists independently evaluated the studies to document asymmetry and stenosis in the jugular veins and prominence of collateral veins.
Results: Asymmetry of internal jugular veins (IJVs) was found in 75 % of subjects. Both observers found stenosis in the IJVs with fair agreement. Most stenoses were located in the upper IJV segments. Asymmetrical vertebral veins and prominence of extracranial collateral veins, in particular the external jugular veins, was not uncommon.
Conclusion: It is common to have stenoses and asymmetry of the IJVs as well as prominence of the collateral veins of the neck in patients without MS. These findings are in contrast to prior reports suggesting collateral venous drainage is rare except in MS patients.