Compressive syndrome of internal jugular veins in multiple sclerosis: does it matter?
Dj Radak, S Tanaskovic⇓, Z Antonic, J Kolar, N Aleksic and N Ilijevski
Vascular Surgery Clinic, ‘Dedinje’ Cardiovascular Institute, School of Medicine, Belgrade University, Belgrade, Serbia
Condition known as chronic cerebrospinal venous insufficiency (CCSVI) is characterized by insufficient cerebral vein drainage in patients with multiple sclerosis (MS) and internal jugular vein (IJV), vertebral and/or azygos veins stenoses. However, external compression on the IJV was not clearly described as a potential cause of CCSVI. We aim to present a case of CCSVI in a patient with MS caused by bilateral IJV inverted valves combined with IJV external compression by carotid bulb.
A 31-year-old female patient was admitted to our institute for IJV and vertebral veins morphological and haemodynamical assessment after being treated for MS for the last 14 years. Colour Doppler ultrasonography showed right IJV prestenotic dilation and inverted valves in both IJV. Computerized tomography angiography showed bilateral IJV compression by carotid bulb. Haemodynamical Doppler parameters showed that external IJV compression significantly contributed to CCSVI occurrence.
Bilateral IJV confluence percutaneous angioplasty (PTA) was done, and the patient was discharged for further neurological examination. Partial carbon dioxide pressure was significantly lower in the distal part of both IJV following PTA and oxygen saturation increased.
In the case presented, PTA of the IJV confluence resulted in haemodynamic improvement despite the presence of IJV external compression.
Ok, the patient had bad valves in both jugulars and compression by the carotid bulb in both jugulars. A 31-year-old patient who'd had MS for 14 years means she was 17 when diagnosed, making this a former case of pediatric MS. But the valves in both jugulars were ballooned and, even though the external compression could not be treated in either jugular, the patient had improvements in blood flow.
I notice that partial carbon dioxide pressure and oxygen saturation in the IJVs is being measured. Should these be measured in other studies, or would they be if this were being looked at exclusively as a venous disease?
The article seems to suggest that compression syndrome does not matter, and that improvement can be seen without treating the compression syndrome. (In this case, the only treatment would be a stent in the IJV next to the carotid bulb which would not be wise because it could irritate the carotid.) This gets back to earlier discussions of physiological stenoses that might come and go based on respiration. The difference between that and an intraluminal stenosis is that the intraluminal stenosis is present all the time.