jugular vein studies

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http://www.ajnr.org/content/22/6/1186.short

The Petrosquamosal Sinus: CT and MR Findings of a Rare Emissary Vein
K. Marsot-Dupucha, M. Gayet-Delacroixa, M. Elmaleh-Bergèsa, F. Bonnevillea and P. Lasjaunias a
+ Author Affiliations

aFrom Service de NeuroRadiologie (K.M-D., F.B., P.I.), Hôpital Bicêtre, Le Kremlin-Bicêtre, Service de Radiologie (M.G-D.), Hôtel Dieu, Nantes, and Service de Radiologie (M.E-B.), Hôpital Robert Debré, Paris, France.
Abstract

BACKGROUND AND PURPOSE: Morphologic changes in the dural sinuses and emissary veins of the posterior fossa relate closely to the development of the brain. We report characteristic findings of imaging in six patients with a rare and forgotten emissary vein called the petrosquamosal sinus (PSS).

METHODS: From a larger group of patients with ear abnormalities, we selected six patients from three ENT imaging centers, because they had CT features suggestive of a PPS. This was the criterion for inclusion in this retrospective study. They were explored by high-resolution CT (HRCT) of the temporal bone. MR venography was performed in three patients to determine the presence and patency of the emissary vein.

RESULTS: The PPS was bilateral in two patients and unilateral in the other four. It affected mainly the left side (left:right ratio, 5:3). Three patients had associated inner ear (n = 2) or middle ear malformations (n = 1). Five of six patients had jugular vein hypoplasia, with development of emissary mastoid veins in three patients.

CONCLUSION: Petrosquamosal sinus can be identified on HRCT in a typical location. It is encountered more frequently in patients referred for congenital abnormalities of the skull base. This rare anatomic variant should be assessed before surgical treatment, because proper identification of these large venous channels would be of interest to the surgeon.

Here in this article on petrosquamosal sinus, it mentions that five of the six patients with this rare emissary vein had jugular vein hypoplasia. Hypoplasia is a very tiny underdeveloped jugular vein. Emissary veins are veins through the skull that present in the fetus but that close up when the jugular veins develop and take over the job of blood flow. If an emissary vein persists into infancy and childhood and adulthood, it is because the jugular vein never sufficiently developed. These five patients with hypoplastic jugulars are CCSVI patients by definition because of the hypoplasia. It would be nice if there were studies supporting the congenital nature of CCSVI because of the existence of the emissary veins.

[Cece]

http://www.medscape.com/viewarticle/765221

CCSVI can give us strokes! Seems like that's a reason for getting angioplasty right there.

Internal jugular vein (IJV) abnormalities are a newly identified risk factor for cerebral venous sinus thrombosis (CVST), a new study shows.

Dr. Jia studied 51 consecutive patients with CVST and 30 healthy control participants using color Doppler flow imaging to evaluate the diameter and maximum flow velocity (Vmax) at 3 points along the IJV — at its influx into the innominate vein (J1), at the point of the superior thyroid vein influx into the IJV (J2), and at the bifurcation level of the common carotid artery (J3).

Among the 51 patients, she identified 31 (60.8%) with IJV abnormalities. Nineteen (61.3%) patients had annulus stenoses, 9 (29.0%) had hypoplastic IJVs, 2 (6.5%) had a thrombosis in the IJV, and 1 (3.2%) had an anomalous valve within the vein. No anomalies were detected in the remaining 20 patients.

Only one anomalous valve was found, as compared to the many bad valves found in MS patients. Are the 3 points that were examined in the area of the valves? I feel like the influx in the innominate vein (J1) is at that area. Are anomalous valves simply difficult to see or are they that much more common among MS patients than they are among CVST patients? Or, wait, the 61% that had annulus stenosis, that sounds like a valve issue.

Anyway, if you have MS and you've had a CVST stroke, you've got twice the reason to get your veins opened. Also, I like that there is reason to study jugular vein obstructions outside of the MS population, because studying them in any population is a way to get them declared as abnormal and in need of treatment, and I think it is unconscionable that treatment of jugular abnormalities is being delayed due to lack of research and lack of agreement about what's abnormal and what's normal. Health delayed is health denied.

New Association

Session moderator Turgut Tatlisumak, MD, PhD, vice chairman of the Department of Neurology and director of the Acute Stroke Unit at Helsinki University Central Hospital in Helsinki, Finland, called the study "very interesting" and said no one had looked at the association of IJV abnormalities and CVST before.

However, because the central venous sinus can extend into the IJV and because patients were evaluated for IJV abnormalities only after a CVST, there is a question of whether the CVST could have caused some of the IJV anomalies. Therefore, Dr. Tatlisumak suggested a prospective study would be needed to resolve this point.

Anyone out there working on that prospective study? This research is from 3 years ago.

[Cece]

http://link.springer.com/article/10.100 ... 925#page-1
This one talks about cooling of the brain. When the body is cool, blood flows from the brain to the face through the emissary veins. When the body is hot, blood flows from the face to the brain through the same veins?! So when the body is hot, the blood is flowing this way to cool the brain, but in person with jugular obstructions, the blood flow wouldn't be able to leave the brain as easily, either adding to the congestion of the brain or preventing blood from flowing from the face to the brain and therefore preventing needed cooling of the brain. And that is why heat intolerance is improved when jugular obstructions are treated? Could be. This is an article from the 80s. This is called selective cooling and it is present in many mammals although as of 1986 there was only indirect evidence of selective cooling in humans.

[Cece]

http://journals.plos.org/plosone/articl ... [quote]The main finding of the study, after adjusting for presence of cardiovascular risk factors, is that IJV CSA enlarges with aging, a phenomenon which is more pronounced in the right IJV than the left IJV, and in males than females.[/quote]
Dr. Zivadinov and Dr. Beggs are listed as authors, along with others.
The IJV enlarges with aging, which may be an indicator of impaired venous drainage that occurs with aging, especially in males. If venous drainage is already impaired due to CCSVI, it would seem that aging would make it worse.
http://phl.sagepub.com/content/early/20 ... 0.abstract
And in this article by the same team, they showed that the increase in area size of the jugular vein was actually a good thing in aging neurologically-normal males because it was correlated with less brain atrophy.

[Cece]

http://www.fasebj.org/content/30/1_Supp ... 62.6.short

An attempt to understand why astronauts are suffering vision issues and increased intracranial pressure after time spent in space. Head-down tilt position was used in study, to create fluid shifts and lower body negative pressure.

[Cece]

Variability in the Cross-Sectional Area and Narrowing of the Internal Jugular Vein in Patients Without Multiple Sclerosis
Karen Buch1, Raymond Groller1, Rohini N. Nadgir1, Akifumi Fujita1, Muhammad M. Qureshi1,2 and Osamu Sakai1,2,3

Affiliations: 1Department of Radiology, Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Bldg, 3rd Fl, Boston, MA 02118.
2Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA.
3Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA.
Citation: American Journal of Roentgenology. 2016;206: 1082-1086. 10.2214/AJR.15.14689

ABSTRACT :
OBJECTIVE. Chronic cerebrospinal vascular insufficiency is a proposed condition of intraluminal stenosis of the internal jugular vein (IJV) that impedes venous flow from the brain. Calculations of IJV stenosis are vague and described in veins with at least a 50% reduction in IJV caliber at a specific level. The purpose of this study was to assess normal changes in anatomic caliber of the course of the IJV in a generalized population.

MATERIALS AND METHODS. Images from 500 consecutive contrast-enhanced neck CT studies performed in January–July 2011 were reviewed. Cross-sectional areas of the IJV were calculated at the jugular foramen, C1–C7 levels, and jugular angles bilaterally. Patients were excluded if they had severely motion-limited studies; limited clinical data; a history of multiple sclerosis, neck mass, or neck dissection; or known IJV occlusion. Normalized IJV cross-sectional areas at each level were compared with an averaged normalized cross-sectional area from all patients at each level.

RESULTS. Greater than 50% narrowing compared with a normalized average was found in 133 of 363 patients (36.6%) and was seen at all IJV levels. In 36.1% of patients this narrowing occurred at the C1 level. Most of the areas of narrowing greater than 50% occurred above the C4 level.

CONCLUSION. The IJV has marked variability in its course in the neck. Areas of narrowing greater than 50% occur most commonly in the upper cervical and skull base regions. Given the normal anatomic variations in IJV caliber, caution should be used when making the diagnosis of and treating IJV stenosis.



Read More: http://www.ajronline.org/doi/abs/10.2214/AJR.15.14689

[Cece]

http://cp.neurology.org/content/6/2/e10.short

Neurologists recommend stenting of the jugular veins, in a case study of a patient with exercise-induced intracranial hypertension due to bilateral jugular vein obstruction.

[Cece]

http://eprints.leedsbeckett.ac.uk/2671/ ... stract.pdf

Cerebral venous drainage and its impact on cerebrospinal fluid motion: a retrospective
review of the work of the ISNVD
Clive Beggs 1,2

1. Buffalo Neuroimaging Analysis Center, University at Buffalo, 100 High St., Buffalo, NY 14203, NY, USA;
2. Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, LS1 3HE, UK

Since the inception of the Society, members of the ISNVD have pioneered work on the interaction
between the cerebrospinal fluid (CSF) system and the cerebral venous drainage system, and its
possible involvement in neurological disease. Initial investigations by ISNVD members involved the
association between multiple sclerosis (MS) and increased CSF pulsatility in the Aqueduct of
Sylvius (AoS) [1,2]. This was followed by a study that reported a similar phenomenon in healthy
adults without neurologic disease [3], suggesting that increased aqueductal pulsatility might be
primarily due to altered intracranial biomechanics associated with constricted cerebral venous
drainage, rather than neuronal decay. This opinion was reinforced by Zivadinov et al., [4] who
performed venous angioplasty on MS patients diagnosed with chronic cerebrospinal venous
insufficiency (CCSVI) and found that the procedure normalized CSF pulsatility in the AoS.
Independent work by Zamboni and co-workers [5] had already shown a 63% increase in the
hydraulic resistance of the extracranial venous pathways in MS patients diagnosed with CCSVI [6].
As such, this body of work indicated a direct biomechanical link between cerebral venous outflow
and the motion of the CSF pulse in the AoS, a link that was later confirmed by Lagana, Beggs and
co-workers in a MRI study that demonstrated a strong positive correlation (r=0.966, P<0.001)
between the intracranial venous blood volume and the aqueductal CSF volume in healthy young
adults [7].

Although the clinical implications of this work are yet to be fully understood, increased CSF
pulsatility in the AoS has been associated with early stage white matter damage (WM) in healthy
individuals without neurologic disease [8]. As such, this appears to support the work of Chung et al
[9], who found jugular venous reflux (JVR) to be associated with more severe age-related WM
changes in the elderly. Collaborative work between Chung, Zivadinov, Beggs and there co-workers
also revealed JVR to be associated with intracranial structural changes in Alzheimer's disease
patients, which resulted in increased gray matter volume [10]. This unexpected finding, which has
since been mirrored in a subsequent study investigating aging in healthy individuals [11], suggests
that venous drainage anomalies may have far reaching neurological implications, leading to
increased venous blood retention in the cranium, something that has the potential to alter the
dynamics of the intracranial CSF system.

This explains the new focus on pulsativity within the Aqueduct of Sylvius within the brain.