Traumatic Bilateral Jugular Vein Thrombosis

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

Traumatic Bilateral Jugular Vein Thrombosis

Postby Cece » Fri Nov 18, 2011 3:45 pm

http://journals.lww.com/neurosurgery/Ab ... se.36.aspx
OBJECTIVE AND IMPORTANCE: Thrombosis of the internal jugular vein (IJV) with associated elevated intracranial pressure (ICP) is a rare complication of central venous catheterization but has not been reported as a result of blunt trauma.

CLINICAL PRESENTATION: An 18-year-old male patient was observed to be obtunded after an assault. The initial examination was remarkable for somnolence, bruising of the anterior neck, and diffuse, edematous swelling of the face and scalp. The results of computed tomography of the brain were normal. An angiogram obtained on the 2nd hospital day to rule out carotid injury revealed bilateral IJV thromboses to the cranial base. An ICP monitor was placed with an opening pressure of 33 mm Hg. The central venous pressure was measured to be 9 mm Hg. A catheter was passed through the left IJV thrombus and into the sigmoid sinus, where the pressure was 17 mm Hg.

INTERVENTION: An intravascular stent was deployed in the left IJV. ICP rapidly normalized. A regimen of coumadin was administered to the patient for 6 weeks, at which time the stent remained patent.

CONCLUSION: We conclude that traumatic jugular vein thrombosis can be associated with significant elevation in ICP and that treatment with an endovascular stent can affect the rapid correction of intracranial hypertension in patients who are candidates for anticoagulation.

Some thoughts: somnolence as a symptom of thrombotic outflow obstruction of the jugulars is similar to fatigue in ccsvi outflow obstruction of the jugulars.

Traumatic assault can damage jugulars. Had only one been damaged, it might have gone undiagnosed.

Clotting extended the length of the jugular to the cranial base. Only one jugular was cleared. It is not said if the other one was unable to be cleared or if this was a choice to clear only one. The jugular was stented. The patient, with one occluded jugular and one stented jugular, is at risk for intimal hyperplasia or clotting in the stent. With the youthful age of the patient, I wonder if he is at risk for MS too.
Last edited by Cece on Tue Nov 22, 2011 2:09 pm, edited 1 time in total.
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Re: Traumatic Bilateral Jugular Vein Thrombosis

Postby MrSuccess » Fri Nov 18, 2011 11:52 pm

Cece , I know it seems like we have alway's had many of the everyday things in our lives that we all take for granted. But this is not so. I speak of - of course - the Internet. The Great Age of Information available for all .........

I speak of MRI's . MRV's. All of these great inventions are new.

In the not too distant past ...... medical professionals depended on textbooks for researching information. A good doctor ......also had a great memory.

Some of these old school health professionals ...... started to notice that some of their previously healthy patients ...... developed MS like symptoms ...... AFTER ...... suffering
some form of TRAUMA.

Eventually , they noticed a pattern . Healthy >>> Trauma >>>> Unhealthy .

Certainly NOT in all cases ...... but enough to draw suspicion.

And as we know ..... where there is smoke ......there is fire.


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Re: Traumatic Bilateral Jugular Vein Thrombosis

Postby Stacemeh » Sat Nov 19, 2011 1:06 am

Interesting,

I remember Lorne Brandes talking about this a while ago.

http://healthblog.ctv.ca/post/CCSVI-tri ... stion.aspx
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Re: Traumatic Bilateral Jugular Vein Thrombosis

Postby Cece » Sat Nov 19, 2011 9:39 am

well, we have a list now of ways trauma could impact CCSVI and MS:

* thrombosis of the jugulars (probably very rare)
* axonal severing due to trauma such as car accident, coupled with pre-existing axonal damage from the CCSVI in MS condition
* misalignment of the spine that diminishes the cerebrospinal flow or the flow through the small veins of the spine which may serve as collaterals for the pre-existing CCSVI condition
* trauma temporarily weakens the blood brain barrier

Trauma would not have caused my valvular bilateral jugular blockages. Bad valves like that are believed to be present from birth, since 'something went wrong' prenatally in the formation/malformation of the valves.

I could see trauma as something that might worsen the situation, tipping a subclinical CCSVI in MS condition into a clinical one.

I would also be careful with our necks! No choking games....
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Re: Traumatic Bilateral Jugular Vein Thrombosis

Postby Donnchadh » Sun Nov 20, 2011 2:36 pm

Personally I am convinced that my problems are entirely due to a severe ladder accident I had back in 1990. The day before the accident, I was in great shape with absolutely no neurological problems of any kind. From the day of the accident forward, my neurological problems progressively became worse. I have had three separate procedures done, by three different Interventional radiologists, and they were able to identify and correct some of the damage.

What is left is stenosis in the sigmoid sinus, and no one knows how to treat it yet. I have evolved my own DIY iron removal procedure, which is keeping me stable. Without the three procedures (which could be done by one procedure today based on improvements) and the iron removal, I would be in very bad shape.

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Re: Traumatic Bilateral Jugular Vein Thrombosis

Postby David1949 » Sun Nov 20, 2011 6:49 pm

Donnchadh
This is a personal question. I hope you won't mind answering it. What kind of injury occurred from the ladder fall? Was there an impact to the head or neck, or bending of the neck?
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Re: Traumatic Bilateral Jugular Vein Thrombosis

Postby Donnchadh » Sun Nov 20, 2011 11:26 pm

I was on a ladder about twenty feet long. Unbeknownst to me, there was "black" ice underneath a fresh snowfall. The ladder slid down along the side of a two story brick apartment. Fortunately, the top edge of the ladder stayed in contact with the bricks as it slid down, somewhat slowing the rate of fall.

Nevertheless, when the ladder with me on top of it hit the ground, it was a tremendous impact. Picture a classic whiplash motion of the head. My forehead hit the ladder rung so hard that it bent the aluminum rung.

Subsequent MRI imaging showed herniated C5-C6 disc's in the neck and inactive lesions in the brain. Back in 1990 no one had heard of CCSVI, so this aspect wasn't investigated. Most of the doctors who had treated me could not give an explanation for the presence of my neurological problems. However, the real reason for that is probably due to the fact that my case was a worker's comp case and the insurance company fought me every inch of the way. They had no incentive to explore all aspects of my case, but rather to try to minimize it.

I should add that I was 43 years old at the time, and never had any neurological symptoms of any kind prior to this accident. From what I have read many MS patients typically start to exhibit some symptoms at a much younger age. I never had an incident of recurring relapse or sickness; just a steady progression over the years.

ETA: My main venous problem areas are the bilateral sigmoid sinus; which was the pivot point for the head backlash. From a MRV I undertook, there is a massive network of collateral veins developed around the sigmoid sinus area to bypass it. Amazingly the team of neurologists who evaluated the MRV images didn't make a single comment about the existence of the collateral veins-which are impossible NOT to notice. Useless.

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Re: Traumatic Bilateral Jugular Vein Thrombosis

Postby drsclafani » Tue Nov 22, 2011 12:04 pm

Donnchadh wrote:Personally I am convinced that my problems are entirely due to a severe ladder accident I had back in 1990. The day before the accident, I was in great shape with absolutely no neurological problems of any kind. From the day of the accident forward, my neurological problems progressively became worse. I have had three separate procedures done, by three different Interventional radiologists, and they were able to identify and correct some of the damage.

What is left is stenosis in the sigmoid sinus, and no one knows how to treat it yet. I have evolved my own DIY iron removal procedure, which is keeping me stable. Without the three procedures (which could be done by one procedure today based on improvements) and the iron removal, I would be in very bad shape.

Donnchadh

stenoses of the dural sinus has been treated by stenting. this has been published. Images in top row are before stenting. arrows in two leftside images point to the stenosis. The article was speaking about the treatment of the stenosis but the use of IVUS for to monitor the treatment of these stenoses.
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Re: Traumatic Bilateral Jugular Vein Thrombosis

Postby Cece » Wed Nov 14, 2012 9:44 am

http://www.amssm.org/atypical_postconcu ... =60&Part=4
Trauma and amyotrophic lateral sclerosis: A report of 78 patients
ABSTRACT— This was a controlled study to assess the possible role of mechanical trauma in the pathogenesis of some cases of amyotrophic lateral sclerosis (ALS). Questionnaires were sent to 181 patients with ALS who had developed the disease before age 45. Among the 135 respondents 78 (58%) reported having sustained injuries severe enough to have required medical attention prior to the onset of their motor neuron illness. Fifty nine (76%) of the ALS patients reporting an earlier trauma had incurred an inury to the head, neck, shoulder and/or arm. For controls, we used the 85 patients with multiple sclerosis who responded to the questionnaires sent them. The findings of this investigation add further evidence that a former injury may be important in the etiology of some cases of ALS developing early in life.

MrSuccess brought up trauma recently in a different thread. I ran across this in a googlescholar search of "soccer" and "multiple sclerosis" after reading Cheer's post over at Facebook. (From the literature, trauma is more associated with ALS, not MS. CCSVI + trauma = ALS ? Totally hypothetical.)

Anyway, this article was relevant to the discussion here because MS patients were used as the controls. Trauma was evident in the history of the patients who developed ALS, but not in the history of the patients who developed MS.
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Re: Traumatic Bilateral Jugular Vein Thrombosis

Postby PointsNorth » Wed Nov 14, 2012 11:35 am

Thx Cece,

I've read that many soccer players have the Parkonsonian symptoms found in boxers given the amount of ball 'heading' that is done over a career. As a player, challenging for a ball (with the head) that has been kicked 50+ yards is a significant jolt to the 'ol noggin'.

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