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Computed tomography venography of the jugular vein. (A) Sagittal and (B) axial views: the distance between the left side of the atlas transverse process and the cranial skull styloid process was narrow (indicated by the arrow). (C) Sagittal and (D) axial views: the entire lumen of the right jugular vein was narrow, and multiple calcified and conglobate circuitous blood vessels were observed in the cranial exit (indicated by the arrows).
Source publication
Rationale
Cerebral venous thrombosis (CVT) comprises a group of cerebral vascular diseases resulting from cerebral venous outflow obstruction caused by various etiologies. The etiology of CVT is complex, including infectious and noninfectious factors. The diagnosis is difficult. As a result, many patients are misdiagnosed or never diagnosed. This p...
Context in source publication
Context 1
... became narrow. Moreover, the lumen of the entire right jugular vein between the jugular foramen and the right subclavian vein was slightly narrower than normal; in addition, we observed multiple calcifications. Conglobate circuitous blood vessels were observed in the cranial exit of the right jugular vein (Fig. 3). The ultrasound findings of the jugular vein indicated asymmetric diameters of the bilateral jugular vein. The venous outflow was hindered in the J2 (midpiece) segment of the bilateral jugular vein. During deep inspiration, the blood flow velocity of the left jugular venous J2 segment became slower along with pipe diameter narrowing. ...
Citations
... in conclusion, 119 patients from 22 studies included in this review (table i). [1][2][3][4][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] last search was performed on 1 June 2021. ...
INTRODUCTION: Internal jugular vein stenosis caused by external compression causes a variety of symptoms, which can lead to under-recognition of this entity. The purpose of this systematic review is to describe the various underlying causes of external compression of the internal jugular vein, as well as diagnosis, management, outcome, and accompanying pathologies. To the best to our knowledge, this is the first systematic review that inspects all the extrinsic musculoskeletal compressors of the internal jugular vein.
EVIDENCE ACQUISITION: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of PubMed was conducted from its inception to 1 June 2021.
EVIDENCE SYNTHESIS: A total of 119 patients, 66 males and 53 females, from 22 studies were included in this review. We divided the etiology into three categories: styloidogenic jugular venous compression (95%), compression caused by osseous structures other than the styloid process and the C1 transverse process (2%), and entrapment by muscular structures (3%). The most common symptoms were headache (52%), tinnitus (48%), and insomnia (46%). Improvement in symptoms after surgery alone or in conjunction with endovascular treatment was seen in 28 of the 31 patients (90%).
CONCLUSIONS: The internal jugular vein compression by musculoskeletal structures is not uncommon. In the “styloidogenic jugular venous compression” group, compression is caused not just by an elongated styloid process, but also by a narrowed distance between the C1 transverse process and the styloid process, as well as anatomical C1 variations. Because compression can only occur in specific positions in some cases, dynamic imaging, which involves creating these positions during imaging, is critical. Many patients benefit from interventional procedures.
... 8,9 IJV abnormalities have also been reported to be associated with CVST, mainly thrombosis, valvular dysfunction, and stenosis. [10][11][12] However, the presence of multiple external compression has not been described in detail. ...
... Extrinsic compression-induced IJV stenosis can block cerebral venous blood outflow. 13 In a report of a 15-year-old female patient, Li et al. 12 stated that CVST might be attributed to local compression of the unilateral IJV by the transverse process of the atlas and styloid process of the cranial skull; such abnormalities may originate from anatomic variations rather than the aging process. In addition, we presumed that severe aging-related degeneration of the intervertebral disks and shortening of the cervical vertebral column in the present case might have narrowed the accommodation space for cervical vessels, also potentially playing a role in blood stagnation. ...
Cerebral venous sinus thrombosis (CVST) is a special subtype of stroke that may be life-threatening in severe cases. CVST has distinct risk factors and is frequently overlooked because of its initially nonspecific clinical presentation. We herein describe a 72-year-old man who developed CVST in the right lateral sinus. Despite the absence of common risk factors in this patient, he developed external compression of the bilateral internal jugular veins by a lateral mass of the C1 vertebra and expansion of the carotid artery. Because of his elevated D-dimer and fibrinogen concentrations, which are associated with ongoing activation of the coagulation system, the patient underwent treatment with batroxobin combined with anticoagulation. Recanalization of the sinus was achieved, and his high intracranial pressure and papilledema remarkably decreased. We conclude that external compression of the internal jugular veins, which can be identified with three-dimensional computed tomography venography, may be an important risk factor for CVST.
... Our results show the most common symptoms of IJVthr include neck pain [2,3,[11][12][13][14][15][16] and headache (see Table 1) [12,[16][17][18][19][20][21][22]. ...
... Laboratory results (Table 1) showed the D-dimer raising [19,25,28] and leukocytosis [3,5,14,25,26,28] were the most common abnormalities. Quite recently, a number of papers focused on symptoms related to IJV obstruction, especially from bone and muscular compression but even from kinking of the carotid arteries. ...
... Several reports described CVT due to the propagation of IJVthr into the intracranial system [19][20][21]88,105,106]. ...
(1) Background: internal jugular vein thrombosis (IJVthr) is a potentially life-threating disease but no comprehensive reviews on etiology, symptomatology, diagnosis and current treatment guidelines are yet available; (2) Methods: we prospectively developed a protocol that defined objectives, search strategy for study identification, criteria for study selection, data extraction, study outcomes, and statistical methodology, according to the PRISMA standard. We performed a computerized search of English-language publications listed in the various electronic databases. We also retrieved relevant reports from other sources, especially by the means of hand search in the Glauco Bassi Library of the University of Ferrara; (3) Results: using the predefined search strategy, we retrieved and screened 1490 titles. Data from randomized control trials were few and limited to the central vein catheterization and to the IJVthr anticoagulation treatment. Systematic reviews were found just for Lemierre syndrome, the risk of pulmonary embolism, and the IJVthr following catheterization. The majority of the information required in our pre-defined objectives comes from perspectives observational studies and case reports. The methodological quality of the included studies was from moderate to good. After title and abstract evaluation, 1251 papers were excluded, leaving 239 manuscripts available. Finally, just 123 studies were eligible for inclusion. We found out the description of 30 different signs, symptoms, and blood biomarkers related to this condition, as well as 24 different reported causes of IJVthr. (4) Conclusions: IJVthr is often an underestimated clinical problem despite being one of the major sources of pulmonary embolism as well as a potential cause of stroke in the case of the upward propagation of the thrombus. More common symptoms are neck pain and headache, whereas swelling, erythema and the palpable cord sign beneath the sternocleidomastoid muscle, frequently associated with fever, are the most reported clinical signs. An ultrasound of the neck, even limited to the simple and rapid assessment of the compression maneuver, is a quick, economic, cost-effective, noninvasive tool. High quality studies are currently lacking.
... e proposed mechanism for cerebral venous (haemorrhagic) infarctions is reduced venous return that leads to high pressure in intracerebral veins. High venous pressure consequently leads to poor arterial perfusion, cell necrosis, and haemorrhages [1,4]. If a venous infarction is evident in a patient with patent cerebral venous sinuses, other rare causes of reduced venous return, such as neck vein pathology, have to be excluded [4]. ...
... High venous pressure consequently leads to poor arterial perfusion, cell necrosis, and haemorrhages [1,4]. If a venous infarction is evident in a patient with patent cerebral venous sinuses, other rare causes of reduced venous return, such as neck vein pathology, have to be excluded [4]. ...
Cerebral venous sinus thrombosis (CVST) is an uncommon disease entity. In contrast-enhanced computed tomography (CT) or magnetic resonance venography (MRV) images of the brain, CVST usually manifests as a filling defect of the dural venous sinuses. Brain parenchymal involvement in CVST can be ranged from parenchymal oedema to haemorrhagic infarctions. Though the most frequent cause of haemorrhagic infarction in brain is CVST, other rare causes such as cerebral venous outflow obstruction due to neck vein pathology have been reported. We report a rare case of haemorrhagic brain infarctions secondary to bilateral internal jugular vein thrombosis in a 17-year-old woman, who has presented with worsening headache and seizures. She had high susceptibility of getting venous thrombosis for being a young female on oral contraceptive pills. While reporting a rare cause of cerebral haemorrhagic infarctions, this case report highlights the need for having a high degree of suspicion to diagnose CVST. Further, this case report emphasises the value of prompt and adequate imaging of neck veins if the haemorrhagic infarction presents with patent cerebral venous sinuses.
... The proposed mechanism for cerebral venous (haemorrhagic) infarctions is reduced venous return that leads to high pressure in intra cerebral veins. High venous pressure consequently leads to poor arterial perfusion, cell necrosis and haemorrhages [1,4]. If a venous infarction is evident in a patient with patent cerebral venous sinuses, other rare causes of reduced venous return, such as neck vein pathology has to be excluded [4]. ...
... High venous pressure consequently leads to poor arterial perfusion, cell necrosis and haemorrhages [1,4]. If a venous infarction is evident in a patient with patent cerebral venous sinuses, other rare causes of reduced venous return, such as neck vein pathology has to be excluded [4]. ...
... IJV thrombosis increases the risk of clot migration and further thrombosis, leading to pulmonary embolism and cerebral vein thrombosis. 3 These risks increase when there is bilateral IJV thrombosis due to significant venous outflow obstruction. 4 Patients with this condition should be started on anticoagulation and monitored for signs of clot migration or worsening thrombosis. The patient was admitted to the ICU for initial monitoring while on anticoagulation due to significant clot burden and was later discharged home on oral anticoagulation without complications. ...
Internal jugular vein (IJV) thrombosis is an unusual condition, especially when it develops bilaterally. This is a case of bilateral IJV thrombosis in a 77-year old female who presented to the emergency department with neck and arm swelling after discontinuing apixaban and undergoing an oropharyngeal procedure. The diagnosis of bilateral IJV thrombosis was made with the use of point-of-care ultrasound to evaluate bilateral jugular vein distention and bilateral upper extremity pitting edema found on her physical examination.
... 20 Anatomical IJV abnormalities, including stenosis, hypoplasia, and abnormal flow, may also play a role in thrombosis formation. [28][29][30] Humans have been flying in space for more than 50 years, yet this is the first report of venous thrombosis during spaceflight, to our knowledge. Given that the thrombi detected in our study were asymptomatic and only discovered in the course of assessing the IJV, it is plausible that undetected thrombi have occurred previously during human spaceflight missions, albeit without negative clinical outcomes attributed to thrombi sequelae to date. ...
Importance
Exposure to a weightless environment during spaceflight results in a chronic headward blood and tissue fluid shift compared with the upright posture on Earth, with unknown consequences to cerebral venous outflow.
Objectives
To assess internal jugular vein (IJV) flow and morphology during spaceflight and to investigate if lower body negative pressure is associated with reversing the headward fluid shift experienced during spaceflight.
Design, Setting, and Participants
This prospective cohort study included 11 International Space Station crew members participating in long-duration spaceflight missions . Internal jugular vein measurements from before launch and approximately 40 days after landing were acquired in 3 positions: seated, supine, and 15° head-down tilt. In-flight IJV measurements were acquired at approximately 50 days and 150 days into spaceflight during normal spaceflight conditions as well as during use of lower body negative pressure. Data were analyzed in June 2019.
Exposures
Posture changes on Earth, spaceflight, and lower body negative pressure.
Main Outcomes and Measures
Ultrasonographic assessments of IJV cross-sectional area, pressure, blood flow, and thrombus formation.
Results
The 11 healthy crew members included in the study (mean [SD] age, 46.9 [6.3] years, 9 [82%] men) spent a mean (SD) of 210 (76) days in space. Mean IJV area increased from 9.8 (95% CI, −1.2 to 20.7) mm² in the preflight seated position to 70.3 (95% CI, 59.3-81.2) mm² during spaceflight (P < .001). Mean IJV pressure increased from the preflight seated position measurement of 5.1 (95% CI, 2.5-7.8) mm Hg to 21.1 (95% CI, 18.5-23.7) mm Hg during spaceflight (P < .001). Furthermore, stagnant or reverse flow in the IJV was observed in 6 crew members (55%) on approximate flight day 50. Notably, 1 crew member was found to have an occlusive IJV thrombus, and a potential partial IJV thrombus was identified in another crew member retrospectively. Lower body negative pressure was associated with improved blood flow in 10 of 17 sessions (59%) during spaceflight.
Conclusions and Relevance
This cohort study found stagnant and retrograde blood flow associated with spaceflight in the IJVs of astronauts and IJV thrombosis in at least 1 astronaut, a newly discovered risk associated with spaceflight. Lower body negative pressure may be a promising countermeasure to enhance venous blood flow in the upper body during spaceflight.
... [25] Reversal of flow in the IJV has also been linked to several neurological conditions, including transient monocular blindness and transient global amnesia, although the exact pathophysiology of these conditions remains unclear. [3,26] Cerebral venous thrombosis is another less common consequence of impaired venous outflow but is a significant source of morbidity. Cerebral venous thrombosis is considerably burdensome to patients, as it can present with severe symptom. ...
Objective
The objectives of this study were to identify the causes of internal jugular vein (IJV) blood flow reversal revealed on ultrasound imaging.
Methods
In this retrospective review, 4796 upper extremity venous ultrasounds completed at a single institution between January 2012 and December 2017 were reviewed to identify cases of flow reversal in the IJV. Fourteen patients were identified with IJV flow reversal. Medical charts of these 14 patients were reviewed to identify the etiology of blood flow reversal.
Results
Intraluminal causes were the most common and were most frequently seen in patients with vascular damage secondary to placement of endovascular devices. Flow reversal most commonly occurred in the left IJV and was equally represented in men and women. Ages ranged from 41.38 to 82.76 years, with an average age of 61.92 years.
Conclusion
Reversal of flow in the IJV is a rare finding which is most often diagnosed on ultrasound evaluation of the upper extremity. Further investigation should be performed when flow reversal is identified, as the underlying cause may have serious clinical implications.
Purpose: This study is to assess the clinical utility of jugular venous flow pattern by evaluating ultrasonography.
Methods: Consecutive 438 patients who underwent carotid artery ultrasonography were enrolled. They were evaluated jugular vein flow patterns and divided into three types: orthodromic, to-and-fro and antidromic. All of them were received MRA and compared to the flow patterns of ultrasonography. The relationship of jugular venous flow pattern and dural arteriovenous fistula (dAVF)/transient global amnesia (TGA) was also assessed.
Results: The to-and-fro or antidromic pattern was significantly associated with older age, but not heart failure, in 81 patients, which was more frequently found on the left side. On MRA, venous flow signals were observed in 28 patients. The to-and-fro or antidromic pattern were more frequently observed on ultrasonography and was significantly associated with venous flow signals on MRA. Four patients who were diagnosed as dAVF showed the orthodromic flow pattern. Twelve patients who were diagnosed as TGA, and five of them showed a to-and-fro or antidromic flow pattern, which was a significantly high frequency.
Conclusions: Assessment of jugular flow patterns by ultrasonography and/or MRA can help the diagnosis of diseases which are supposed to jugular venous flow abnormality.
