"Chicken or egg? MS is a disease with extensive gray matter involvement; it causes damage and loss of gray matter. Gray matter is metabolically active, i.e. requires glucose and oxygen to function, these are delivered by the blood. If you have lost gray matter you get reduced blood flow, i.e. the remaining tissue needs less blood. So this study is simply stating the obvious. There is no evidence that reduced blood flow precedes the loss of gray matter in MS. This is another factor that needs to be taken into account by proponents of the vascular theory of MS; shrinkage of the brain or atrophy due to loss of brain tissue occurs throughout the course of MS and is linked to reduced blood flow. Therefore detecting reduced flow in say the veins draining the brain does not imply that it is causing MS, it is simply a consequence of the loss of brain tissue."