Email updates

Keep up to date with the latest news and content from BMC Neurology and BioMed Central.

Open Access Research article

Internal jugular venous abnormalities in transient monocular blindness

Chun-Yu Cheng135, Feng-Chi Chang24, A-Ching Chao67, Chih-Ping Chung13* and Han-Hwa Hu135*

Author Affiliations

1 Department of Neurology, Neurological Institute, Taipei -Veterans General Hospital, Taipei, Taiwan

2 Department of Radiology, Taipei -Veterans General Hospital, Taipei, Taiwan

3 Department of Neurology, Institute of Brain Science, National Yang-Ming University School of Medicine, Taipei, Taiwan

4 Department of Radiology, Institute of Brain Science, National Yang-Ming University School of Medicine, Taipei, Taiwan

5 Institute of Brain Science, National Yang-Ming University School of Medicine, Taipei, Taiwan

6 Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan

7 Department of Neurology, Kaohsiung Medical University School of Medicine, Kaohsiung, Taiwan

For all author emails, please log on.

BMC Neurology 2013, 13:94  doi:10.1186/1471-2377-13-94

Published: 22 July 2013

Abstract

Background

The etiology of transient monocular blindness (TMB) in patients without carotid stenosis has been linked to ocular venous hypertension, for their increased retrobulbar vascular resistance, sustained retinal venule dilatation and higher frequency of jugular venous reflux (JVR). This study aimed to elucidate whether there are anatomical abnormalities at internal jugular vein (IJV) in TMB patients that would contribute to impaired cerebral venous drainage and consequent ocular venous hypertension.

Methods

Contrast-enhanced axial T1-weighted magnetic resonance imaging (MRI) was performed in 23 TMB patients who had no carotid stenosis and 23 age- and sex-matched controls. The veins were assessed at the upper IJV (at C1–3 level) and the middle IJV (at C3–5 level). Grading of IJV compression/stenosis was determined bilaterally as follows: 0 = normal round or ovoid appearance; 1 = mild flattening; 2 = moderate flattening; and 3 = severe flattening or not visualized.

Results

There was significantly more moderate or severe IJV compression/stenosis in the TMB patients at the left upper IJV level and the bilateral middle IJV level. Defining venous compression/stenosis scores ≥ 2 as a significant cerebral venous outflow impairment, TMB patients were found to have higher frequency of significant venous outflow impairment at the upper IJV level (56.5% vs. 8.7%, p = 0.0005) and the middle IJV level (69.6% vs. 21.7%, p=0.0011).

Conclusions

TMB Patients with the absence of carotid stenosis had higher frequency and greater severity of IJV compression/stenosis which could impair cerebral venous outflow. Our results provide evidence supporting that the cerebral venous outflow abnormality is one of the etiologies of TMB.

Keywords:
Transient monocular blindness; Internal jugular vein; Venous outflow abnormalities; Jugular venous reflux; Venous hypertension; Chronic cerebrospinal venous insufficiency