OBJECTIVE: This study is the first in a series investigating the relationship 
between autonomic nervous system dysfunction and chronic cerebrospinal venous 
insufficiency in multiple sclerosis patients. We screened patients for the 
combined presence of the narrowing of the internal jugular veins and symptoms of 
autonomic nervous system dysfunction (fatigue, cognitive dysfunction, sleeping 
disorders, headache, thermal intolerance, bowel/bladder dysfunction) and 
determined systolic and diastolic blood pressure responses to balloon 
angioplasty.
METHODS: The criteria for eligibility for balloon angioplasty intervention 
included ≥ 50% narrowing in one or both internal jugular veins, as determined by 
the magnetic resonance venography, and ≥ 3 clinical symptoms of autonomic 
nervous system dysfunction. Blood pressure was measured at baseline and 
post-balloon angioplasty.
RESULTS: Among patients who were screened, 91% were identified as having 
internal jugular veins narrowing (with obstructing lesions) combined with the 
presence of three or more symptoms of autonomic nervous system dysfunction. 
Balloon angioplasty reduced the average systolic and diastolic blood pressure. 
However, blood pressure categorization showed a biphasic response to balloon 
angioplasty. The procedure increased blood pressure in multiple sclerosis 
patients who presented with baseline blood pressure within lower limits of 
normal ranges (systolic ≤ 105 mmHg, diastolic ≤ 70 mmHg) but decreased blood 
pressure in patients with baseline blood pressure above normal ranges (systolic 
≥ 130 mmHg, diastolic ≥ 80 mmHg). In addition, gender differences in baseline 
blood pressure subcategories were observed.
DISCUSSION: The coexistence of internal jugular veins narrowing and symptoms of 
autonomic nervous system dysfunction suggests that the two phenomena may be 
related. Balloon angioplasty corrects blood pressure deviation in multiple 
sclerosis patients undergoing internal jugular vein dilation. Further studies 
should investigate the association between blood pressure deviation and internal 
jugular veins narrowing, and whether blood pressure normalization affects 
Patient's clinical outcomes.