Diagnostic value of transcranial Doppler in the assessment of cerebral regulation mechanism in multiple sclerosis in supine and tilt up position

Abstract Background Multiple sclerosis (MS) is a prevalent acquired chronic demyelinating disorder affecting 2.8 million individual worldwide, causing disability in 5–10% of them. It mainly affects young and middle aged population. MS can be associated with vascular dysfunction and cerebral autoregulation. Cerebral autoregulation is the capability of the brain to maintain a constant blood flow despite changes in the cerebral perfusion pressure. In our study, we aimed to assess the changes in cerebral blood flow (CBF) velocity and detect changes in the cerebral autoregulations in MS patients. Methods Our study was an observational prospective study conducted from May 2023 to December 2023. It included 58 participants, 29 multiple sclerosis proven cases based on McDonald’s criteria, and 29 control subjects who were normal healthy individuals with matched age and sex with those in the case group. Transcranial Doppler and carotid duplex examinations were done for all participants. Results The study results showed significant difference in mean values of peak systolic velocities (PSV) of both common and internal carotid arteries on both sides between cases and controls being higher in MS patients. There were higher peak and mean velocity values of the middle cerebral artery in cases than in controls in both supine and tilt up positions reaching a statistical significance on the left side in the supine position. No statistically significant difference was noted in percentage decrease in middle cerebral artery (MCA) PSV in tilt up position between cases and controls with no significant correlation with disease duration or expanded disability status scale (EDSS). The MCA resistivity index (RI) and pulsatility index (PI) were significantly higher in cases than in controls. Conclusion This study showed increased flow velocities in internal carotid and middle cerebral arteries of the cases possibly could be due to the higher blood pressure values in patients than in controls, the study also showed increased RI and PI values in MCA in MS patients than in controls which could suggest an abnormal vascular compliance in these patients. Finally, no significant difference was noted between MS patients and normal population regarding their cerebral autoregulation. This study values the role of transcranial color Doppler in early detection of cerebral vascular changes in MS patients, either cerebral hypoperfusion or elevated blood pressure affecting the cerebral parenchyma.