Jugular Vein Abnormalities Linked to Venous Sinus Thrombosis

Daniel M. Keller, PhD

June 07, 2012

June 7, 2012 (Lisbon, Portugal) — Internal jugular vein (IJV) abnormalities are a newly identified risk factor for cerebral venous sinus thrombosis (CVST), a new study shows.

In addition, color Doppler flow imaging is an efficient modality for examining the IJV and identifying lesion types, Lingyun Jia, MD, from the Department of Vascular Ultrasonography at Xuanwu Hospital and Capital Medical University in Beijing, China, reported here at the XXI European Stroke Conference.

CVST is a unique form of stroke generally affecting younger people. It is associated with a high risk for recurrence, disability, and mortality. The cavernous sinus, through the petrosal sinus, communicates with the sigmoid sinus, and the petrosal and sigmoid sinuses together form the IJV.

Dr. Jia studied 51 consecutive patients with CVST and 30 healthy control participants using color Doppler flow imaging to evaluate the diameter and maximum flow velocity (Vmax) at 3 points along the IJV — at its influx into the innominate vein (J1), at the point of the superior thyroid vein influx into the IJV (J2), and at the bifurcation level of the common carotid artery (J3).

Among the 51 patients, she identified 31 (60.8%) with IJV abnormalities. Nineteen (61.3%) patients had annulus stenoses, 9 (29.0%) had hypoplastic IJVs, 2 (6.5%) had a thrombosis in the IJV, and 1 (3.2%) had an anomalous valve within the vein. No anomalies were detected in the remaining 20 patients.

About 60% of abnormalities occurred on the left side, 30% on the right, and 10% bilaterally. About 85% were at the J3 point (common carotid bifurcation), with the rest occurring equally at J1 and J2. In the case of unilateral IJV lesions, the CVST always occurred on the side of the lesion. For the 4 patients with bilateral lesions, 1 CVST occurred on each side and 2 bilaterally.

In healthy control participants, the diameters of the IJVs averaged 7.1 mm on the left and 7.4 mm on the right, with Vmax of 45.8 ± 10.7 cm/s and 49.8 ± 12.2 cm/s, respectively. In contrast, the minimum diameter of the IJV on the side of a unilateral lesion was significantly smaller (2.1 ± 1.1 mm) than on the contralateral side (6.2 ± 3.0 mm, P < .001).

The Vmax on the side with a unilateral annulus stenosis was significantly greater than on the unaffected side (110.5 ± 49.7 cm/s vs 68.7 ± 29.5 cm/s, respectively, P < .05). However, unilateral IJV hypoplasia was associated with a lower Vmax (45.3 ± 28.6 cm/s vs 87.5 ± 39.7 cm/s, P < .05).

The 30 healthy control individuals showed no significant differences in diameter or Vmax between the left and right IJVs at the 3 points.

Dr. Jia concluded that IJV abnormalities are a risk factor for CVST and that color Doppler flow imaging detects the presence and type of lesions. But she cautioned that more research is needed to evaluate the effects of possible intervention on the IJV on the recurrence and long-term outcomes of CVST in individuals with IJV abnormalities.

New Association

Session moderator Turgut Tatlisumak, MD, PhD, vice chairman of the Department of Neurology and director of the Acute Stroke Unit at Helsinki University Central Hospital in Helsinki, Finland, called the study "very interesting" and said no one had looked at the association of IJV abnormalities and CVST before.

However, because the central venous sinus can extend into the IJV and because patients were evaluated for IJV abnormalities only after a CVST, there is a question of whether the CVST could have caused some of the IJV anomalies. Therefore, Dr. Tatlisumak suggested a prospective study would be needed to resolve this point.

He said it is probably not worth screening healthy people for IJV abnormalities, and if abnormalities are found incidentally, intervention is not warranted at this point. He suggested just informing the patient about the finding. Although none of the healthy control participants had any sign of an IJV abnormality, it is not known how many people may harbor such a condition and never have a problem.

Dr. Jia disclosed no relevant financial relationships. Dr. Tatlisumak was not involved with the study and disclosed no relevant financial relationships.

XXI European Stroke Conference. Presented May 23, 2012.

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