As this review outlines, there are observable and documented differences between the jugular veins of healthy controls, when compared to people with Multiple Sclerosis. These pathological differences involve the endothelial cells which comprise the veins' lining. Endothelial cell aptosis (death) and derangement, as seen in MS, changes the ability of the jugular veins to drain. Valvular and intraluminal abnormalities in the jugular veins of people with MS have hemodynamic implications. There is a shift in collagen in the jugular veins of people with MS which affects venous compliance.
Veins have received little attention and research, when compared to the study and understanding of arteries. Certainly, in terms of brain health, the carotid arteries are scanned and studied, and neurology and stroke researchers know that blockages, clots, and impairment in flow can be disastrous to the brain. There are treatment modalities developed to deal with carotid artery issues---from medications to open surgery, to interventional proceedures. No one questions the importance of healthy blood flow to the brain.
But the venous system and the removal of fluids from the brain is even more important than previously imagined.
During the past two years, international researchers have described a newly discovered lymphatic drainage system, which has actual draining vessels, and relies on the brain's draining veins. These vessels take lymph fluid, carrying metabolites, proteins and toxins, out of the brain. This process is aided by sleep. This science is brand new. It has reversed what we once believed was the brain's "immune privilege."
This "stunning discovery" of a lymphatic drainage system relies on the jugular veins.
"Instead of asking, 'How do we study the immune response of the brain?' 'Why do multiple sclerosis patients have the immune attacks?' now we can approach this mechanistically. Because the brain is like every other tissue connected to the peripheral immune system through meningeal lymphatic vessels," said Jonathan Kipnis, PhD, professor in the UVA Department of Neuroscience and director of UVA's Center for Brain Immunology and Glia (BIG).
The brain is like every other organ in our body---it needs drainage. Jugular veins are responsible for the exit of blood, cerebrospinal fluid (CSF) and lymph. Any delays can cause changes to the brain's immune functioning, oxygenation, glucose metabolism and health. Delays cause neuronal death and inflammation. Or, what we see in multiple sclerosis.
Dr. Jonathan Kipnis, the discoverer of these lymphatic vessels, will be the keynote speaker at the International Society for Neurovascular Disease. He will be presenting his research and proposals for studies in MS, alongside Dr. Zamboni and the other members of the ISNVD.
Here's the program. “How the Extracranial Venous System Influences Neurological Diseases.”
This is not going away.
jugular veins are important,
Notice the difference between the top panel---healthy endothelial cells lining the jugular veins in normal controls, compared to the endothelial cells of a person with MS (bottom)
Figure 5: Scanning electronic microscopy. Top panel: regular disposition of the endothelial cells in IJVs of healthy controls, respectively at 800x (right) and 1500x (left). Bottom panel: irregular arrangement of the endothelial cells in the IJV of a MS patient, respectively at 800x (left) and 1500x (right). The cells appear lifted with craters.