We describe a multiple sclerosis patient presenting with compression of the internal jugular vein caused by aberrant omohyoid muscle. Previously this patient underwent balloon angioplasty of the same internal jugular vein. Ten months after this endovascular procedure, Doppler sonography revealed totally collapsed middle part of the treated vein with no outflow detected. Still, the vein widened and the flow was restored when the patient’s mouth opened. Thus, the abnormality was likely to be caused by muscular compression. Surgical exploration confirmed that an atypical omohyoid muscle was squeezing the vein. Consequently, pathological muscle was transected. Sonographic control three weeks after surgical procedure revealed a decompressed vein with fully restored venous outflow. Although such a muscular compression can be successfully managed surgically, future research has to establish its clinical relevance.
The full article is available. This is a case study from Dr. Simka. The patient had muscular compression of the jugular. Flow was physiological, sometimes closed, sometimes functional. The vein would open when the patient opened her mouth. Treatment was by transecting the muscle, but although flow was improved, it did not result in any MS improvements. What is interesting also is that no other stenoses were found, only the muscular compression of one jugular. I would suggest that this patient would benefit from another look-over of the usual veins. I know there are patients in whom only one narrowing is found, but for the only narrowing to be a physiological narrowing seems like a rarity to me. This is with all respect to Dr. Simka who is not only one of the CCSVI pioneers but also contributing to the CCSVI medical literature by publishing on what he has seen.
edit: ok upon rereading, I think the left jugular did have both the muscular compression and a bad valve.