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What Is CCSVI in Multiple Sclerosis?

A Brief Explanation of Chronic Cerebrospinal Venous Insufficiency

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Updated January 07, 2010

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

CCSVI stands for chronic cerebrospinal venous insufficiency. Basically, this means that there are blockages and narrowing of some of the most important veins that drain the blood from the brain (and rest of the central nervous system) back to the heart. While there are other conditions of narrowed veins (mostly occurring in the legs, but also sometimes in the spine), CCSVI has only recently been described by Dr. Paolo Zamboni of Ferrara, Italy, and this condition has not yet been confirmed the medical establishment.

Dr. Zamboni proposes that multiple sclerosis (MS) is caused by CCSVI. The cause of MS is still unknown, but most experts say that it is an autoimmune disease, triggered by an infection, faulty vitamin D metabolism, genetics, or a combination of all of these things. Until now, CCSVI has not been explored as a link to MS. While this is an exciting and promising new theory, many experts are cautious about supporting the idea until more research is done - however, many patients are embracing the small amount of data as the answer to the mystery of MS, so I think it's important to look at what's known and not known about this emerging theory.

Let's start with a very basic explanation of what CCSVI is and how it has been linked to MS by Dr. Zamboni and colleagues:

The evidence from some studies in people with MS shows that these blockages lead the body to find alternate routes to shunt the blood out of the central nervous system. This leads to strange flow patterns, as the blood has to use other vessels to get back to the heart. The deoxyginated blood does not exit the central nervous system efficiently – it may flow very slowly, leading to swelling or leakage of red blood cells into the brain or spine. It also may back up (called reflux).

According to Dr. Zamboni and others, this slow or reversed blood flow leads to iron deposits and autoimmune activity, which (according to this theory) accounts for the lesions that are found in the brains and spinal cords of people with MS.

Now, let's look at what might be causing CCSVI: What Causes CCSVI?

Sources:

Singh AV, Zamboni P. J Cereb Blood Flow Metab. 2009 Sep 2. Anomalous venous blood flow and iron deposition in multiple sclerosis.

Zamboni P, Consorti G, Galeotti R, et al. Venous collateral circulation of the extracranial cerebrospinal outflow routes. Curr Neurovasc Res. 2009 Aug;6(3):204-12.

Zamboni P, Galeotti R, Menegatti E, et al. J Neurol Neurosurg Psychiatry. 2009 Apr;80(4):392-9. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis.

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