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Internal jugular vein valve incompetence and intracranial venous anatomy in transient global amnesia

S J Schreiber¹, F Doepp¹, R Klingebiel² and J M Valdueza¹

¹ Department of Neurology, University Hospital Charité, Berlin, Germany
² Neuroradiology Section of the Department of Radiology, University Hospital Charité, Berlin, Germany

Correspondence to:
Correspondence to:
Stephan J Schreiber
Department of Neurology, University Hospital Charité, Schumannstr. 20/21, 10117 Berlin, Germany; Stephan.Schreiber{at}charite.de

Background: Recently a causal relation between internal jugular vein valve incompetence (IJVVI) and transient global amnesia (TGA) has been suggested. IJVVI is postulated to provoke a transient mesiotemporal ischaemia by venous congestion. This mechanism requires a patent venous pathway from the affected IJV through the transverse sinus, confluens, straight sinus (SS), vein of Galen into the basal vein of Rosenthal and the internal cerebral veins.

Objective: To study IJVVI in TGA patients in relation to the intracranial venous anatomy.

Methods: IJVVI was defined if a repeated Valsalva manoeuvre (VM) led to a retrograde jugular flow detected by extracranial duplex ultrasound. Non-contrast venous MR angiography (MRA) was performed to analyse intracranial drainage patterns of the SS in relation to the side of the IJVVI. SS drainage was differentiated into three groups: predominantly right, left, and bilateral drainage. Ultrasound studies were performed in 25 TGA patients and 85 age matched controls. Twenty patients underwent venous MRA.

Results: Sixty eight per cent of patients and 33% of controls showed unilateral or bilateral IJVVI (p = 0.0025). In 36% of patients a TGA preceding VM was reported. Drainage pattern of SS and side of IJVVI corresponded in five of eight patients (63%) with VM and four of 12 patients without VM (33%, p = 0.0994).

Conclusion: Our study confirms the significantly higher prevalence of IJVVI in TGA patients. However, no specific IJVVI related intracranial venous drainage patterns could be found to further support the hypothesis of a direct causal relation between IJVVI and TGA.

Abbreviations: IJV, internal jugular vein; IJVVI, internal jugular vein valve incompetence; MIP, maximum intensity projections; MRA, magnetic resonance angiography; SS, straight sinus; TGA, transient global amnesia; TOF, time-of-flight; VM, Valsalva manoeuvre

Keywords: straight sinus; ultrasound; Valsalva; venous MR angiography

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