Cervical spondylotic internal jugular venous compression syndrome

[pattismith]

@mattie

Cervical spondylotic internal jugular venous compression syndrome

Jia‐Yue Ding

First published: 22 May 2019

Abstract

Aims

This study aimed to identify the clinical profiles of cervical spondylosis‐related internal jugular vein stenosis (IJVS) comprehensively.

Methods

A total of 46 patients, who were diagnosed as IJVS induced by cervical spondylotic compression were recruited. The clinical manifestations and imaging features of IJVS were presented particularly in this study.

Results

Vascular stenosis was present in 69 out of the 92 internal jugular veins, in which, 50.7% (35/69) of the stenotic vessels were compressed by the transverse process of C1, and 44.9% (31/69) by the transverse process of C1 combined with the styloid process. The transverse process of C1 compression was more common in unilateral IJVS (69.6% vs 41.3%, P = 0.027) while the transverse process of C1 combined with the styloid process compression had a higher propensity to occur in bilateral IJVS (52.2% vs 30.4%, P = 0.087). A representative case underwent the resection of the elongated left lateral mass of C1 and styloid process. His symptoms were ameliorated obviously at 6‐month follow‐up.

Conclusions

This study proposes cervical spondylotic internal jugular venous compression syndrome as a brand‐new cervical spondylotic subtype. A better understanding of this disease entity can be of great relevance to clinicians in making a proper diagnosis.

...
Intro:

Our study group discovered that some nonfocal neurological symptoms like headache, head noise, tinnitus, and visual impairment are tightly correlated to unilateral or bilateral IJVS, and balloon dilation with stenting in the stenotic segment may be a promising option to overcome nonimmunogenic and nonextrinsic compression IJVS‐induced jugular venous outflow impairment

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[pattismith]

@mattie

from the same team D.Zhou
Departments of Neurology, Neurosurgery, and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China
in 2017

Intracranial hypertension induced by internal jugular vein stenosis can be resolved by stenting


Abstract

Background and purpose

Idiopathic intracranial hypertension (IIH) is characterized by abnormally elevated intracranial pressure (ICP) without identifiable etiology. Recently, however, a subset of patients with presumed IIH have been found with isolated internal jugular vein (IJV) stenosis in the absence of intracranial abnormalities.

Methods

Fifteen consecutive patients were screened from 46 patients suspected as IIH and were finally confirmed as isolated IJV stenosis. The stenotic IJV was corrected with stenting when the trans‐stenotic mean pressure gradient (∆MPG) was equal to or higher than 5.44 cmH2O. Dynamic magnetic resonance venography, computed tomographic venography and digital subtraction angiography of the IJV, ∆MPG, ICP, Headache Impact Test 6 and the Frisén papilledema grade score before and after stenting were compared.

Results

All the stenotic IJVs were corrected by stenting. ∆MPG decreased and the abnormal collateral veins disappeared or shrank immediately.

Headache, tinnitus, papilledema and ICP were significantly ameliorated at 14 ± 3 days of follow‐up (all P < 0.01). At 12 ± 5.6 months of outpatient follow‐up, headache disappeared in 14 out of 15 patients (93.3%), visual impairments were recovered in 10 of 12 patients (83.3%) and tinnitus resolved in 10 out of 11 patients (90.9%). In 12 out of 15 cases, the Frisén papilledema grade scores declined to 1 (0–2). The stented IJVs in all 15 patients kept to sufficient blood flows on computed tomographic venography follow‐up without stenting‐related adverse events.

Conclusions

Non‐thrombotic IJV stenosis may be a potential etiology of IIH. Stenting seems to be a promising option to address the issue of intracranial hypertension from the etiological level, particularly after medical treatment failure