Background/Objective(s)

In recent years, several studies have reported vascular abnormalities in patients with multiple sclerosis (MS). Epidemiological data suggest that patients with MS might have an increased risk of developing ischemic stroke. Imaging studies in patients with MS suggest a decrease in cerebral perfusion that affects widespread areas including the normal-appearing white matter (NAWM). In addition, MS has been associated with reduced CNS venous blood drainage, which is referred to as chronic cerebrospinal venous insufficiency (CCSVI).

Material(s) and Method(s)

Two groups were recruited in the present study:

First group: 30 patients from inpatient and outpatient Neuropsychiatry department in Assuit university hospital were diagnosed with MS according to the revised 2017 McDonald's criteria.

Second group: 30 healthy volunteer subjects matched with age, sex and education level.

Inclusion criteria: Patients diagnosed with MS or with clinically isolated syndrome (CIS) highly suggestive of MS according to revised 2017 McDonald's criteria; MS patients aged 18-60 years of both sexes; Expanded Disability Status Scale (EDSS) score 1-7.

Exclusion criteria: History or current evidence of CNS diseases; psychiatric or other drugs which may affect brain volume and cognition.

An assessment of cerebral circulation hemodynamics for both sides was done by the high resolution color duplex Philips Envisor C Ultrasound System with L 12-3 MHz linear transducer probe. Hamilton Depression Rating Scale (HDRS) and Mini-mental State Examination (MMSE) were used as neuropsychiatric assessment scales.

Result(s)

Cerebrovascular hemodynamic insufficiency was significantly prominent in patients with MS mainly in the anterior and posterior parts with lower affection of carotid circulation. Different significant correlation levels found between HDRS, MMSE, and EDSS and affected vessels indicated that the cerebral vessels changes affect the MS-related progression and disability.

Conclusion(s)

Patients with MS seem to have an increased risk for ischemic stroke. Endothelial dysfunction secondary to inflammatory responses or raised homocysteine concentrations might play a part, but reduced cerebral blood flow might predispose patients to the development of these ischemic brain lesions. The widespread cerebral hypoperfusion in MS seems not to be secondary to axonal degeneration, but might be a result of reduced axonal activity, reduced astrocyte energy metabolism, and perhaps increased blood concentrations of endothelin-1(ET-1). Impaired cerebral perfusion can be related to the cognitive manifestation of the disease, which is a common symptom associated with substantial decline in activities of daily living.