The diagnosis of multiple sclerosis with markers of "better explanation": accuracy of the "central vein sign" in uncovering pathogenic mechansms different from inflammatory demyelination

In systemic autoimmune diseases with neurological involvement, brain lesions are mainly and periarteriolar and micro-ischemic. In these diseases central vein sign (CVS) frequency in the white matter is lower than 50% (Maggi et al, in press). In this study differences in the CVS frequency are analyzed in MS and in MS patients with clinical, laboratory or MRi markers of “better explanation” of the diagnosis (MS-plus) not fulfilling the criteria of another diagnosis. The low frequency of the CVS observed in most of the MS-plus suggests a non inflammatory-demyelinating underlying pathology. CVS seems a useful marker for increasing the accuracy of the MS diagnostic criteria