Internal jugular vein valve incompetence and intracranial venous anatomy in transient global amnesia
- 1Department of Neurology, University Hospital Charité, Berlin, Germany
- 2Neuroradiology Section of the Department of Radiology, University Hospital Charité, Berlin, Germany
- Correspondence to: Stephan J Schreiber Department of Neurology, University Hospital Charité, Schumannstr. 20/21, 10117 Berlin, Germany;
- Received 20 April 2004
- Accepted 6 August 2004
- Revised 6 July 2004
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.
- 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
Competing interests: this study was supported by a grant from the Schering Forschungsgesellschaft mbH, Berlin, Germany.