Autonomic dysfunction: a unifying multiple sclerosis theory, linking chronic cerebrospinal venous insufficiency, vitamin D(3), and Epstein-Barr virus

Autoimmunity Reviews
Zohara Sternberg

Abstract

Multiple sclerosis (MS) is a disease with multiple etiologies. The most recent theory of the vascular etiology of MS, Chronic Cerebrospinal Venous Insufficiency (CCSVI), suggests that cerebral venous obstruction could lead to cerebral venous reflux, promoting local inflammatory processes. This review article offers strong evidence that the route of the observed narrowing of cerebral veins arises from autonomic nervous system dysfunction, particularly cardiovascular autonomic dysfunction. The dysfunction of this system has two major effects: 1) the reduction of mean arterial blood pressure, which has the potential to reduce the cerebral perfusion pressure and the transmural pressure, and 2) the failure of cerebral autoregulation to maintain constant cerebral blood flow in the face of fluctuations in cerebral perfusion pressure. Alterations in cerebral autoregulation could in turn raise the critical closure pressure, indicated to be the cerebral perfusion pressure at which the transmural pressure will be sub-sufficient to overcome the active tension imparted by the smooth muscle layer of the vessel. These two effects of autonomic nervous system dysfunction (reduction in arterial blood pressure and alterations in cerebral autoregu...Continue Reading

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Citations

Dec 15, 2012·Clinical Reviews in Allergy & Immunology·Nancy Agmon-LevinYehuda Shoenfeld
Aug 18, 2012·Journal of Neuroinflammation·Gehan A Mostafa, Laila Y Al-Ayadhi
Jun 11, 2014·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Michael Arata, Zohara Sternberg
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Nov 21, 2013·Phlebology·Zohara SternbergMichael Arata
Jun 21, 2015·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Zohara Sternberg
May 3, 2013·Expert Review of Clinical Immunology·Carlo PerriconeYehuda Shoenfeld
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Jan 1, 2015·Immunologic Research·Elias Toubi
Nov 11, 2021·ASN Neuro·Hayder M Al-KuraishyGaber El-Saber Batiha

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