central venous stenosis

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

central venous stenosis

Postby Cece » Wed Nov 16, 2011 12:28 pm

http://radiology.rsna.org/content/247/2 ... gures-only
Here are some images from a study on MRVs of central venous stenosis. Starting in figure 2b you see a series of stenosed internal jugular veins. I would assume that these are "acute" occlusions, such as what happens when a jugular clots suddenly.

However looking at the images here and then looking at my own MR images, they have a lot in common.
www.thisisms.com/forum/chronic-cerebros ... ml#p146167
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Re: central venous stenosis

Postby Cece » Wed Nov 16, 2011 12:48 pm

http://www.ncbi.nlm.nih.gov/pubmed/12116103
J Clin Ultrasound. 2002 Jul-Aug;30(6):392-8.

Color Doppler sonographic finding of retrograde jugular venous flow as a sign of innominate vein occlusion.

Conkbayir I, Men S, Yanik B, Hekimoğlu B.

Department of Radiology, Social Security Ankara Hospital, TR-06110 Dişkapi, Ankara, Turkey.

Abstract

Occlusion or stenosis of the superior vena cava, the innominate vein, or both is an important clinical problem that requires prompt diagnosis. To confirm a suspected occlusion, imaging studies revealing the obstruction and the presence of collateral venous routes are needed. Color Doppler sonography (CDUS) is widely used to evaluate suspected venous thrombosis and collateral pathways. We present the CDUS findings in 2 cases of innominate vein occlusion. In case 1, CDUS of the neck and left upper arm, which harbored a permanent hemodialysis access, showed engorged veins in the upper arm, a patent dialysis access, and some collateral veins in the axilla. The subclavian and internal jugular veins were patent, but the flow in the left internal jugular vein was reversed. The left innominate vein was occluded. In case 2, CDUS of the upper arms showed that the veins, the dialysis access in the left upper arm, and the subclavian and jugular veins were patent, but the flow in the left internal jugular vein and in the right subclavian vein was reversed. Collateral veins were seen in the right axillary region. Both innominate veins were occluded. The resulting collateral pathways, ie, retrograde flow in the ipsilateral jugular vein crossing to the contralateral jugular vein through dural sinuses, were confirmed by venography in both cases.

Because of stenoses in both the left and right innominate vein, the flow went up the left jugular, across the dural sinuses, and down the right jugular. (case 2)

Because of a left innominate vein occlusion, the flow in the left jugular was reversed. (case 1)

Reflux/retrograde flow up the jugular exists in other patients with central venous occlusions, just as it does in us with our jugular occlusions.

Here's another case of a patient with reverse jugular flow.
http://ang.sagepub.com/content/47/7/699.abstract
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Re: central venous stenosis

Postby Cece » Wed Nov 16, 2011 12:56 pm

http://www.ajnr.org/content/24/7/1364.short
Retrograde Flow in the Left Inferior Petrosal Sinus and Blood Steal of the Cavernous Sinus Associated with Central Vein Stenosis: MR Angiographic Findings

Yahya Paksoya,
Bülent Oğuz Gençb and
Emine Gençb

bSelçuk University School of Medicine, Department of Neurology, Konya, Turkey

Abstract

BACKGROUND AND PURPOSE: We attempted to identify the cause of abnormal venous flow seen during arterial MR angiography in the inferior petrosal sinus by use of in three female patients (aged 51, 48, and 70 years, respectively).

METHODS: Arterial 3D time-of-flight MR angiography was performed with a tilted optimized nonsaturating excitation pulse sequence (TR/TE, 31/7; flip angle, 20 degrees; section thickness, 65 mm; effective thickness, 1 mm; number of sections, 1 to 2); no magnetization transfer pulse sequence was used. Contrast-enhanced 3D MR angiography of the neck was performed with a 3D fast low-angle shot pulse sequence (TR/TE, 4.6/1.8; flip angle, 40 to 45 degrees; section thickness, 80 mm; intersection gap, 1.5 mm; acquisition matrix, 180 × 256; acquisition time, 27 s) on a system with a whole-body coil.

RESULTS: In all three patients, 3D time-of-flight MR angiography revealed abnormal vascular signal originating from the left cavernous sinus, continuing through the inferior petrosal sinus, and ending in the proximal internal jugular vein at the jugular bulb level. Abnormal vascular signal at the jugular bulb, sluggish flow and flow-related enhancement in the left internal jugular vein, and signal void in the contralateral jugular vein were noted. Contrast-enhanced delayed-phase MR angiography showed stenosis in the left brachiocephalic vein in all patients.

CONCLUSION: High signal intensity noted at the inferior petrosal sinus resulted from retrograde flow. Retrograde flow was due to blood stealing from the internal jugular vein toward the cavernous sinus because of venous stenosis in the brachiocephalic vein.

Here's where the inferior petrosal sinuses are:
http://en.wikipedia.org/wiki/Inferior_petrosal_sinus
Notice the brain in very very close proximity.
Retrograde flow in the jugulars due to a central venous stenosis resulted in retrograde flow in the sinuses of the brain.

Dr. Zamboni's research did not come out of nowhere. Terms like retrograde flow and central venous stenosis already existed to describe what he found. His brilliance was in finding these obstructions and these flow abnormalities in a specific patient population (us).
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Re: central venous stenosis

Postby cheerleader » Wed Nov 16, 2011 1:30 pm

Cece wrote:
Dr. Zamboni's research did not come out of nowhere. Terms like retrograde flow and central venous stenosis already existed to describe what he found. His brilliance was in finding these obstructions and these flow abnormalities in a specific patient population (us).


Thanks for all these wonderful references, Cece. You are SO right. This did not come out of the ether. Dr. Dake said to us, when he looked at Jeff's MRV images, it reminded him of the central venous stenosis he had treated in vena cava syndrome. It was not new for him, at all. He treated dozens of cases with venoplasty. And he said, after the fact, that the symptom relief Jeff experienced reminded him of the relief his patients had experienced after he repaired central venous stenosis. The vascular doctors get this...the neurologists, not as much.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: central venous stenosis

Postby Cece » Wed Nov 16, 2011 7:10 pm

Thanks, cheer. While I wouldn't expect a neurologist to have to be an expert on this, when it's not their specialty, I would have expected them to acknowledge when it was outside of their specialty, and then give the vascular experts room to do the research as needed, without all the derision.
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