This Is MS Multiple Sclerosis Community: Knowledge & Support

Internal jugular vein (IJV) is a main extracranial route for cerebral venous drainage. The jugular venous valves, which are located near the junction with the innominant vein, prevent the transmission of thoracic pressure and the reflux of venous blood into the cerebral circulation. Jugular valve insufficiency could result in retrograde jugular venous flow and back transmission of central venous pressure.

We need working jugular vein valves. Unless you plan on never turning your head upside down, or sneezing, or straining on the john, or lifting something, or getting stressed, or having sex, or doing the myriad of everyday activities that causes blood to go back up the jugular veins and into the brain. The IJVVs are the only thing between the heart and the brain protecting from venous backflow...and we are JUST beginning to learn about their importance.

In particular, we assessed the presence, morphology and competence of valves at their ostium. Unilateral jugular vein valves were present in 406 cases (88%), mainly on the right side. The most frequently observed morphology (75%, 305 cases) was the two-leaflet valve, and jugular vein valves were incompetent in the huge majority of cases (365 cases, 90%). Our findings confirm the anatomical variability predicted from classical anatomical studies but, unluckily, do not provide additional evidence on the possible role of jugular vein valves in physiology and pathology. Further studies are strongly needed to determine whether these valves actually play an important role in counteracting chest venous pressure and in preventing reflux towards the brain.

Indeed, further studies are needed to evaluate whether there is a real increased prevalence of jugular vein valve absence or incompetence in patients with transient global amnesia or, more likely, whether the presence of at least one competent valve acts as a protective factor from cerebral venous engorgement in the case of increased chest venous pressure. Some authors suggest to concentrating on valve motion instead of competence, being this aspect complex and various, and probably the real index of valve function (Morimoto et al., 2009).

The competence of the IJV valve is crucial in maintaining the transcranial blood pressure gradient during cardiopulmonary resuscitation with closed-chest compression.(7) This valve also prevents a sudden increase in the IJV pressure during coughing or during positive pressure ventilation and may thus protect the brain from acute increases in intrathoracic pressure.(8,9) This feature is unimportant in neurologically normal patients, but may be important in patients with compromised cerebral perfusion (e.g.,after head trauma or neurosurgery) .(10) At the same time the functional or morphological incompetence or absence of the IJV valves may cause cough headache, cerebral morbidity after positive end-expiratory pressure ventilation and some types of cerebrovascular diseases.(6) Transient mesiotemporal ischemia induced by venous congestion may be a potential cause of transient global amnesia (TGA).(11) In 1998, Lewis originally proposed the venous congestion hypothesis for TGA.(11) which is primarily based on the observation that the onset of symptoms is often correlated with prior Valsalva-like activities, which in turn may lead to venous reflux through the IJV. In anatomical studies, aplasia is reportedly present in as many as 16% of non-selected patients but in these studies valve competence was not assessed.(12) In humans approximately 90% of internal jugular veins have a valve.

We report the case of a 78-year-old Caucasian man with jugular valve incompetence who experienced an intra-cerebral temporo-occipital hemorrhage following sexual intercourse. He had no other risk factors for an intra-cerebral hemorrhage.

Several (not necessarily mutually exclusive) pathophysiologic processes may cause or contribute to cough-related syncopes, including Valsalva-induced decreased cardiac output, increased intracranial pressure, cardiac arrhythmias, stimulation of a hypersensitive carotid sinus, cough-triggered neural reflex-mediated hypotension-bradycardia, laryngospasm, augmentation of left ventricular outflow obstruction, impaction of a brainstem herniation, decreased cerebral blood flow, internal jugular vein valve insufficiency, and rarely seizures.

Transient global amnesia (TGA) is associated with an increase in the prevalence of jugular insufficiency. Valvular insufficiency may lead to increased venous pressure transmission during a Valsalva maneuver and thus contribute to venous ischemia in TGA. The association of valvular insufficiency and longer reflux times with the occurrence of a trigger event further suggests that cerebral venous congestion is an important etiological factor in transient global amnesia.

We report the case of a 78-year-old Caucasian man with jugular valve incompetence who experienced an intra-cerebral temporo-occipital hemorrhage following sexual intercourse. He had no other risk factors for an intra-cerebral hemorrhage.

I am not sure whether those of who have valve problems can ever have working valves. Mine were ballooned, not disrupted or torn. Based on my improvements in health, I am better off without the valves as obstructions, although maybe not as well off as I'd be if I had normal, functional valves. But normal functional valves may never have been an option for me! I agree that the disruption or tearing of valves does not have science to support it, nor to my knowledge is anyone who is doing this gathering data on outcomes. My biggest concern with it is that other doctors have said they have seen more complications in patients who have had their valves torn, compared to those who have had their valves ballooned. If there was anything that frightened me when going in for CCSVI treatment, it was the possibility of complications. You all had convinced me of the importance of jugulars and azygous veins and I did not want any damage done to them.

How about child birth? The pushing involved in that must cause a valsalva maneuver?