In a new review article in Lancet Neurology, Belgian neurologists have summarised the existing knowledge about problems with blood supply and drainage of the brain in people with multiple sclerosis.
They highlight three possible vascular problems: an increased incidence of stroke in people with MS, lower blood flow through the brain, and the recently described entity of chronic cerebrospinal venous insufficiency (CCSVI).
They note that people with MS appear to have about a two-thirds higher risk of stroke than healthy people, and that this may be due to endothelial dysfunction (problems with the small cells lining the blood vessels) and inflammation.
Studies have also revealed a lower blood flow through the brain of people with MS, and this appears to correlate well with cognitive decline. This is possibly related to poor energy turnover in brain cells (reinforcing the work of Dr Terry Wahls on mitochondria, the parts of cells that produce energy).
Finally, in probably the most recent and balanced summary of the work on CCSVI to date, the authors note that there is no compelling evidence that CCSVI is a cause of MS, and that there is currently no solid evidence of venous outflow obstruction in MS.