JUGULAR VEIN COMPRESSION

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

JUGULAR VEIN COMPRESSION

Postby dania » Sat Nov 05, 2011 10:24 am

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Re: JUGULAR VEIN COMPRESSION

Postby Cece » Sat Nov 05, 2011 2:48 pm

Neurosurgery. 2011 Aug 19. [Epub ahead of print]

Styloidogenic Jugular Venous Compression Syndrome: Diagnosis and Treatment.

Dashti SR, Nakaji P, Hu YC, Frei DF, Abla AA, Yao T, Fiorella D.

Source

1Norton Neuroscience Center, Norton Healthcare, Louisville, KY; 2Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; 3Division of Neurosurgery and Neuroradiology, Cerebrovascular Center, State University of New York at Stony Brook, Stony Brook, NY; 4Swedish Medical Center, Englewood, CO.

Abstract

BACKGROUND AND IMPORTANCE:

Intracranial venous hypertension is known to be associated with venous outflow obstruction. We discuss the diagnosis and treatment of mechanical venous outflow obstruction causing pseudotumor cerebri.

CLINICAL PRESENTATION:

We report two patients presenting with central venous outflow obstruction secondary to osseous compression of the internal jugular veins at the craniocervical junction. The point of jugular compression was between the lateral tubercle of C1 and a prominent, posteriorly located styloid process. In both cases catheter venography showed high-grade jugular stenosis at the level of C1 with an associated pressure gradient. The dominant jugular vein was decompressed after the styloid process was resected. Postoperative imaging confirmed resolution of the jugular stenosis and normalization of preoperative pressure gradients. In both cases the symptoms of intracranial hypertension resolved.

CONCLUSION:

Intracranial venous hypertension may result from extrinsic osseous compression of the jugular veins at the skull base. Although rare, this phenomenon is important to recognize because primary stenting is not only ineffective, it may actually exacerbate the outflow obstruction. The osseous impingement of the dominant jugular vein can be relieved via a decompressive styloidectomy, and the clinical results can be excellent.

This reminds me of discussions of idiopathic intracranial hypertension, which can exist at normal pressure.
http://en.wikipedia.org/wiki/Idiopathic ... pertension

It's always good to see it acknowledged that outflow obstructions can have an effect on the organ whose outflow is obstructed.
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Re: JUGULAR VEIN COMPRESSION

Postby Cece » Sat Nov 05, 2011 2:54 pm

http://www.neworleanschiropractic.net/c ... nment.html

This does not have anything to do with jugular vein compression, does it? The spinal vertebrae may affect the cerebrospinal flow or the spinal cord, and maybe the smaller veins of the spine, but not the jugulars, which are further away.
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Re: JUGULAR VEIN COMPRESSION

Postby Filmmaker » Thu Nov 10, 2011 4:35 pm

by the way idiopathic cranial hypertension is very well treated by a gastric bypass...yup... so maybe whatver is causing the compression is coming from the stomach... I guess research still has a long way to go....
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Re: JUGULAR VEIN COMPRESSION

Postby Cece » Thu Nov 10, 2011 6:37 pm

Filmmaker wrote:by the way idiopathic cranial hypertension is very well treated by a gastric bypass....

in morbidly obese patients....
www.uptodate.com/contents/idiopathic-in ... -treatment
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Re: JUGULAR VEIN COMPRESSION

Postby civickiller » Fri Nov 11, 2011 6:20 am

Cece wrote:This does not have anything to do with jugular vein compression, does it? The spinal vertebrae may affect the cerebrospinal flow or the spinal cord, and maybe the smaller veins of the spine, but not the jugulars, which are further away.

it does, a misaligned c1 can cause c1 to impinge the jugular vein

2nd part to the first upright mri study
http://www.sfgate.com/cgi-bin/article.c ... 929674.DTL

watch the 3 videos
http://www.uppercervicalcare.com/index. ... Itemid=217
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Re: JUGULAR VEIN COMPRESSION

Postby Cece » Fri Nov 11, 2011 10:23 am

I checked for any mention of jugular veins in the upright MRI article but did not see it.
The most dramatic MRV image I can remember was posted back in 2009, with an atlas bone seeming to be the cause of occlusion, but there was no mention of an easy fix for this occlusion through chiropractic care.
chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic8515.html?sid=624b92ffff68832b8b802270b36c51cd#p71888
Now that more is known, would this be considered a physiological occlusion and as long as there is no compression on the other side, would treating the valve at the base of the jugular result in improved flow up by where the bone appears to be indenting the vein? Has anyone heard from the original poster since then?
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Re: JUGULAR VEIN COMPRESSION

Postby Cece » Wed Jan 18, 2012 6:47 pm

www.ncbi.nlm.nih.gov/pubmed/12227629
Med Biol Eng Comput. 2002 Jul;40(4):423-31.

Circulatory effects of internal jugular vein compression: a computer simulation study.

Bosnjak R, Kordas M.

Department of Neurosurgery, University Hospital Center, Ljubljana, Slovenia.

Abstract

The effects of compression of the internal jugular veins and the inferior vena cava are simulated using an equivalent electronic circuit, which included simulation of cardiocirculatory phenomena and special features of the cerebral circulation. Compression of the inferior vena cava resulted in a profound decrease in cardiac output (from 4.5 to 1.51min(-1)) and arterial pressure (from 140/85 to 50/35 mmHg). Compression of the internal jugular veins resulted in a negligible decrease in cardiac output and arterial pressure, with a cerebral blood flow that was slightly decreased. Cerebral capillary and internal jugular pressures were considerably increased, leading to obstruction of cerebral veins and increased pressure (from 9 to 22 mmHg) and volume (from 120 to 145 ml) of the cerebrospinal fluid (CSF). Increased cerebral capsule compliance resulted in decreased CSF pressure (from 9 to 8.5 mmHg), but CSF volume increased (from 120 to 190 ml). A small increase in brain volume (from 1,000 ml to 1,060 ml, 6% volume increase) was compensated for by an equal decrease in the volume of CSF. When brain volume was above 1,080 ml, the absorption of CSF was reduced, and its pressure increased.


and this one:
http://www.ajronline.org/content/142/2/403.full.pdf
Jugular Vein Obstruction Caused by Turning of the Head

It mentions that in a study of dural sinuses, only 57% of sinuses had free communication across all sinuses and both sides. Thus if there is one-sided obstruction, the sinus might not be the safety net that diverts blood flow easily to the other side. Sinuses are a part of the CCSVI picture.

The article also talks about compression of the jugular when you turn your head. If you turn your head to the right, the right jugular is compressed but the left remains open.
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Re: JUGULAR VEIN COMPRESSION

Postby Cece » Wed Jan 18, 2012 6:54 pm

www.ncbi.nlm.nih.gov/pubmed/21866063
Neurosurgery. 2011 Aug 19. [Epub ahead of print]

Styloidogenic Jugular Venous Compression Syndrome: Diagnosis and Treatment.

Dashti SR, Nakaji P, Hu YC, Frei DF, Abla AA, Yao T, Fiorella D.

Source

1Norton Neuroscience Center, Norton Healthcare, Louisville, KY; 2Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; 3Division of Neurosurgery and Neuroradiology, Cerebrovascular Center, State University of New York at Stony Brook, Stony Brook, NY; 4Swedish Medical Center, Englewood, CO.

Abstract

BACKGROUND AND IMPORTANCE:

Intracranial venous hypertension is known to be associated with venous outflow obstruction. We discuss the diagnosis and treatment of mechanical venous outflow obstruction causing pseudotumor cerebri.

CLINICAL PRESENTATION:

We report two patients presenting with central venous outflow obstruction secondary to osseous compression of the internal jugular veins at the craniocervical junction. The point of jugular compression was between the lateral tubercle of C1 and a prominent, posteriorly located styloid process. In both cases catheter venography showed high-grade jugular stenosis at the level of C1 with an associated pressure gradient. The dominant jugular vein was decompressed after the styloid process was resected. Postoperative imaging confirmed resolution of the jugular stenosis and normalization of preoperative pressure gradients. In both cases the symptoms of intracranial hypertension resolved.

CONCLUSION:

Intracranial venous hypertension may result from extrinsic osseous compression of the jugular veins at the skull base. Although rare, this phenomenon is important to recognize because primary stenting is not only ineffective, it may actually exacerbate the outflow obstruction. The osseous impingement of the dominant jugular vein can be relieved via a decompressive styloidectomy, and the clinical results can be excellent.

I should probably know what a 'styloid process' is. But it sounds like it can be removed altogether. Does anyone here at TiMS have osseous impingmenet of the jugular vein, and is a decompressive styloidectomy an option that has ever been suggested? I wonder! I also love articles in which the words jugulars and outflow obstructions are used in the same sentences. :)
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Re: JUGULAR VEIN COMPRESSION

Postby blossom » Wed Jan 18, 2012 7:46 pm

it makes no sence that blood flow can "only" be hindered from the inside of a jugular or vein. or even csf flow. compression no matter what the source would have to have an effect. try tieing something around a leg, arm or finger. leave it on there long enough and you are in trouble. why would it be any different with jugulars or arteries. why wouldn't skull compression or vertebra compression be different? compression is compression. whatever the hinderance it's bound to produce bad results.

civickiller is right.
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Re: JUGULAR VEIN COMPRESSION

Postby 1eye » Thu Jan 19, 2012 2:59 pm

A small increase in brain volume (from 1,000 ml to 1,060 ml, 6% volume increase) was compensated for by an equal decrease in the volume of CSF. When brain volume was above 1,080 ml, the absorption of CSF was reduced, and its pressure increased.


OK so veins are obstructed downstream of the brain. The first thing to react is the brain volume increase, due to the vein compliance, but there is only so much room to grow because of the non-compressibility of fluids and the reduced absorption of CSF, which is mostly surrounded by bone, and has nowhere it can go (where is is it to be absorbed to?), so the pressure on the fluids (venous blood and CSF) has to increase. That's also why Dr. Haacke measures an increase in the excursion of the velocity of the blood to higher levels.

Sound accurate?

I find the electrical model fascinating. I have always thought of electronics as a form of plumbing.
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Re: JUGULAR VEIN COMPRESSION

Postby Cece » Thu Jan 19, 2012 3:08 pm

I think so, 1eye. One of the articles mentioned a reduced volume of CSF when there is jugular compression. There is also a greater volume of fluids in the neck of MS patients, as measured by plethysmography.
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Re: JUGULAR VEIN COMPRESSION

Postby Amir » Fri Jan 20, 2012 1:30 pm

Cece wrote:http://www.ncbi.nlm.nih.gov/pubmed/21866063
Neurosurgery. 2011 Aug 19. [Epub ahead of print]

Styloidogenic Jugular Venous Compression Syndrome: Diagnosis and Treatment.

Dashti SR, Nakaji P, Hu YC, Frei DF, Abla AA, Yao T, Fiorella D.

Source

1Norton Neuroscience Center, Norton Healthcare, Louisville, KY; 2Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; 3Division of Neurosurgery and Neuroradiology, Cerebrovascular Center, State University of New York at Stony Brook, Stony Brook, NY; 4Swedish Medical Center, Englewood, CO.

Abstract

BACKGROUND AND IMPORTANCE:

Intracranial venous hypertension is known to be associated with venous outflow obstruction. We discuss the diagnosis and treatment of mechanical venous outflow obstruction causing pseudotumor cerebri.

CLINICAL PRESENTATION:

We report two patients presenting with central venous outflow obstruction secondary to osseous compression of the internal jugular veins at the craniocervical junction. The point of jugular compression was between the lateral tubercle of C1 and a prominent, posteriorly located styloid process. In both cases catheter venography showed high-grade jugular stenosis at the level of C1 with an associated pressure gradient. The dominant jugular vein was decompressed after the styloid process was resected. Postoperative imaging confirmed resolution of the jugular stenosis and normalization of preoperative pressure gradients. In both cases the symptoms of intracranial hypertension resolved.

CONCLUSION:

Intracranial venous hypertension may result from extrinsic osseous compression of the jugular veins at the skull base. Although rare, this phenomenon is important to recognize because primary stenting is not only ineffective, it may actually exacerbate the outflow obstruction. The osseous impingement of the dominant jugular vein can be relieved via a decompressive styloidectomy, and the clinical results can be excellent.

I should probably know what a 'styloid process' is. But it sounds like it can be removed altogether. Does anyone here at TiMS have osseous impingmenet of the jugular vein, and is a decompressive styloidectomy an option that has ever been suggested? I wonder! I also love articles in which the words jugulars and outflow obstructions are used in the same sentences. :)


I think what needs a comment is the sentence: "The point of jugular compression was between the lateral tubercle of C1 and a prominent, posteriorly located styloid process."

The styloid process is normally located well away from the Atlas tubercle lying anterior and lateral to the transverse process of the Atlas unlike what was found in these two patients where the styloid process was "prominent and posteriorly located".

The Atlas is far more likely to be rotated forward on one side and end up causing varying degrees of obstruction and perhaps a consequent increase in veinous and CSF pressure.

The sheath covering the internal jugular vein just below the skull also encases the cranial nerves IX (Glossopharyngeal nerve), X (Vagus), XI(Accesory) and XII(Hypoglossal nerve). Any impingement of the jugular by a rotated Atlas vertebra inevitable affects the function of these nerves also causing various effects throughout the body.
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Re: JUGULAR VEIN COMPRESSION

Postby Cece » Tue Feb 21, 2012 9:24 am

http://www.isnvd.org/files/ISNVD%20Abstract%20Book.pdf
from the isnvd 2012 consensus document:
Frequently, the transverse process of the C1 vertebra will visibly indent the jugular vein (since the vein lies on this bony structure) however, a balloon will inflate under minimal pressure and Valsalva maneuver will enlarge the compressed vein during angiography or IVUS confirming this normal relationship.
The atlas is the c1 vertebra. This is saying that the atlas does frequently indent the IJV but that the vein is able to increase in size (and is not compressed between the atlas and another structure, which would make expansion of the vein impossible). Because the vein can increase in size, flow can get through. This is unlike the situation at the valves, when the valves are fixed, and that fixed stenosis is not able to increase in size.
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Re: JUGULAR VEIN COMPRESSION

Postby civickiller » Wed Feb 22, 2012 2:27 am

the vein can expand because c1 is movable with c2 front to back but because the muscles holding c1 in place learned that crooked position it will move back to that relearned position.

maybe thats why the ccsvi surgeries benefits arent lasting that long for some. this makes sense to me as to why my first ucc adjustment i found the same benefits as those who only felt symptom relief with the ccsvi surgery and why some people are needing to have the surgery over and over again

i like this ucc theory because its more provable than alot of the ccsvi assumptions.

im not saying ucc is the magic cure, i wish it was. ccsvi dr's need to start looking beyond what they think they know, just like what Dr Flanagan is with ccsvi. this is imo, it makes more sense
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