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The Jugular Venous Pulse (JVP) is considered a reliable parameter for the assessment of Central Venous Pressure (CVP). Here, the functionality of a cervical contact plethysmography system designed for non-invasive and operator-independent acquisition of the JVP signal, is shown. To validate the signal, it was recorded in supine and sitting positions, together with the reference Electrocardiography (ECG), on 26 healthy subjects. In the supine acquired signal, the characteristic JVP waves (a, c, v) and the negative deflections (x, y) are well recognizable. In the sitting recorded signal, the systolic peak b and the d incisura of the Common Carotid Artery (CCA) waveform are recognized. For each signal, we calculated the Fraction of the Cardiac Cycle (ccf) represented by the time intervals between the JVP peaks and the ECG peaks, in the form: ΔtaP, ΔtcR, ΔtxP, ΔtvT, Δtyv, Δtvx, and Δtxa. The same was done for the CCA waveform, in the form: ΔtbS, ΔtbT, Δtdb, ΔtdS, and ΔtdT. This system could mitigate risks and costs associated with central venous catheterization and its potential extends to applications in telemedicine, sports medicine, and space medicine.

Dural sinus malformations (DSMs) are rare congenital vascular diseases characterized by a giant venous pouch with or without arteriovenous shunts. We present a neonatal case of DSM that was diagnosed prenatally and treated via endovascular intervention in the early postnatal period. The patient presented with a large DSM involving the torcular Herophilion prenatal magnetic resonance imaging (MRI). Enlargement of the head circumference and respiratory failure rapidly progressed after birth. On the 5th day after birth, the neonate underwent endovascular occlusion via the umbilical artery. The arteriovenous shunt was occluded, and the reflux from the enlarged venous pouch to the dural sinus was decreased. No additional procedure other than ventriculoperitoneal shunting was required. The neonate's development slowly caught up to normal parameters. Follow-up MRI demonstrated the successful development of the venous drainage system. DSMs are characterized by an abnormally dilated dural sinus, which can block the venous return and ultimately increase intracranial pressure and cerebral ischemia. Long-term follow-up indicates that an abnormally developed dural sinus can be reconstructed by appropriate and timely treatment. [ABSTRACT FROM AUTHOR]

It is well known that the space environment induces major alterations to various human physiological systems, determining a general deconditioning of the body. Medical research programs aim to keep the astronaut’s health status during the mission, enable their ready operation once they arrive at their destination, and allow their safe recovery when returned to Earth. Among the programs coordinated and supported by the Italian Space Agency (ASI), the experiments called Drain Brain, performed by the University of Ferrara, are particularly relevant in this respect. The project, which began with the collaboration of Samantha Cristoforetti in 2014, has demonstrated the capability of a plethysmograph system to study the cerebral circulation and the venous return from the brain to the heart, onboard the International Space Station (ISS). Demonstrating the progressive reduction of the cross-sectional area of the internal jugular vein, particularly significant between pre-flight data collection and the last assessment after 6 months of flight on the ISS (p

It is well known that the space environment induces major alterations to various human physiological systems, determining a general deconditioning of the body. Medical research programs aim to keep the astronaut's health status during the mission, enable their ready operation once they arrive at their destination, and allow their safe recovery when returned to Earth. Among the programs coordinated and supported by the Italian Space Agency (ASI), the experiments called Drain Brain, performed by the University of Ferrara, are particularly relevant in this respect. The project, which began with the collaboration of Samantha Cristoforetti in 2014, has demonstrated the capability of a plethysmograph system to study the cerebral circulation and the venous return from the brain to the heart, onboard the International Space Station (ISS). Demonstrating the progressive reduction of the cross-sectional area of the internal jugular vein, particularly significant between pre-flight data collection and the last assessment after 6 months of flight on the ISS (p<0.001). Over the next two years, thanks to the Drain Brain 2.0 project, crews of the International Space Station will be studied with a new version of the plethysmograph, synchronized with the electrocardiogram, to assess cardiac efficiency and brain drainage in relation to symptoms such as blurred vision, numbness, or the feared onset of jugular thrombosis, that is linked to blood flow slowdown due to the absence of the gravitational gradient. Drain Brain 2.0 will also generate important returns to Earth, closing the virtuous circle of terrestrial application of space research. [ABSTRACT FROM AUTHOR]

A 54-year-old woman with no relevant medical history presented with severe headache, nausea, and vomiting for 8 days. Imaging examination revealed a subarachnoid hemorrhage in the left interpeduncular cistern without aneurysms. Computed tomography angiography and digital subtraction angiography found an anomalous vein near the site of the hemorrhagic clots, indicating abnormalities in cerebral venous drainage that provided an anastomosis between the drainage system of the deep middle cerebral, petrosal, and lateral mesencephalic veins. In the primitive pattern, the basal vein of Rosenthal drains into the lateral mesencephalic vein and to the petrosal sinus. This anomalous flow may predispose to subarachnoid hemorrhage, emphasizing the association between nonaneurysmal perimesencephalic hemorrhage and venous anomalies. [ABSTRACT FROM AUTHOR]

The jugular venous pulse (JVP) is a one of the crucial parameters of efficient cardiovascular function. Nowadays, limited data are available regarding the response of JVP to exercise because of its complex and/or invasive assessment procedure. The aim of the present work is to test the feasibility of a non-invasive JVP plethysmography system to monitor different submaximal exercise condition. Twenty (20) healthy subjects (13M/7F mean age 25 ± 3, BMI 21 ± 2) underwent cervical strain-gauge plethysmography, acquired synchronously with the electrocardiogram, while they were carrying out different activities: stand supine, upright, and during the execution of aerobic exercise (2 km walking test) and leg-press machine exercise (submaximal 6 RM test). Peaks a and x of the JVP waveform were investigated since they reflect the volume of cardiac filling. To this aim, the Δax parameter was introduced, representing the amplitude differences between a and x peaks. Significant differences in the values of a, x, and Δ ax were found between static and exercise conditions (p < 0.0001, p < 0.0001, p < 0.0001), respectively. Particularly, the Δ ax value for the leg press was approximately three times higher than the supine, and during walking was even nine times higher. The exercise monitoring by means of the novel JVP plethysmography system is feasible during submaximal exercise, and it provides additional parameters on cardiac filling and cerebral venous drainage to the widely used heartbeat rate value. [ABSTRACT FROM AUTHOR]

Objective: Surgical intervention is commonly necessary for craniosynostosis. One of the preoperative concerns revolves around the cerebral venous drainage pattern and its potential involvement during surgery. Although there have been reports regarding venous drainage patterns in syndromic craniosynostosis, studies of nonsyndromic cases have been rare. In the present study, the aim was to study venous drainage patterns in nonsyndromic craniosynostosis., Methods: Nonsyndromic cases at a single institute were retrospectively reviewed, and cerebral venous drainage in the posterior (transverse sinus [TS]) and anterior (cavernous sinus [CS] and para-CS [ParaCS]) venous routes was systematically investigated. The occipital sinus (OS) and emissary veins were also evaluated., Results: A total of 89 nonsyndromic cases were evaluated, including 12 right coronal synostosis (RCS), 14 left coronal synostosis (LCS), 15 bilateral coronal synostosis (BCS), 36 sagittal synostosis, 6 metopic synostosis, and 6 combined metopic-sagittal synostosis cases. All venous studies were performed using MR venography. There was a significant difference among all six groups in TS dominance (p = 0.0108). In unilateral coronal synostosis (UCS; including RCS and LCS) cases, 76.9% had TS dominance on the opposite side of the synostotic suture (20 of 26 UCS, including 10 of 12 RCS and 10 of 14 LCS). There was a significant difference in the incidence of OS, with the highest incidence observed in the BCS group (33.3%, p = 0.027). CS/ParaCS venous drainage was observed in 94.4% of cases on the right side and 95.5% on the left side, showing no significant difference among the groups on both sides. No visible emissary vein was observed in any of the groups., Conclusions: A significantly higher predominance of left TS was found in RCS cases, in contrast with the typical right-side predominance seen in the normal population. In addition, the majority of UCS cases exhibited TS dominance on the opposite side of the synostotic suture. Furthermore, the present results showed a significant difference in the prevalence of OS, which was predominantly observed in BCS cases. These findings could be explained by the induction effect on venous sinuses by the compensatory growth of the skull according to Virchow's law, suggesting that synostotic sutures induce compensatory skull expansion in regions farthest (diagonally) from the affected sutures, thereby enlarging nearby venous sinuses.

The natural history of cranial dural arteriovenous fistulas (DAVFs) without cortical venous drainage (i.e., benign DAVF) is considered a potential predictor of a benign clinical course. We report a case of intracerebral hemorrhage due to the conversion from a benign to an aggressive DAVF during 10 months of conservative therapy, which, to the best of our knowledge, is the first reported case of its kind. A woman in her 70s without neurological symptoms was diagnosed with DAVF of the right transverse-sigmoid sinus with Borden type I. After conservative therapy was maintained for 10 months, she had a slight headache without neurological deficits and magnetic resonance imaging revealed intracerebral hemorrhage in the right temporooccipital area. Routine laboratory tests revealed a slight elevation of D-dimer. Emergent digital subtraction angiography demonstrated new cortical venous drainage and stenosis of the venous outlet. The refluxed cortical vein and right transverse-sigmoid sinus including fistulas were occluded with coils via transvenous embolization. She had no neurological deficits in the postoperative state. Conversion to aggressive DAVF in this patient was probably due to spontaneous stenosis or thrombosis of the venous outflow. Intracranial hemorrhage can occur within 1 year from the detection of benign DAVFs, and elevated D-dimer may predict the conversion to aggressive DAVFs. [ABSTRACT FROM AUTHOR]

Internal jugular veins (IJVs) are the largest veins in the neck and are considered the primary cerebral venous drain for the intracranial blood in supine position. Any reduction in their flow could potentially results an increase in cerebral blood volume and intracranial pressure (ICP). The right internal jugular vein communicates with the right atrium via the superior vena cava, in which a functional valve is located at the union of the internal jugular vein and the superior vena cava. The atrium aspiration is the main mechanism governing the rhythmic leaflets movement of internal jugular vein valve synchronizing with the cardiac cycle. Cardiac contractions and intrathoracic pressure changes are reflecting in Doppler spectrum of the internal jugular vein. The evaluation of the jugular venous pulse provides valuable information about cardiac hemodynamics and cardiac filling pressures. The normal jugular venous pulse wave consists of three positive waves, a, c, and v, and two negative waves, x and y. A normal jugular vein gradually reduces its longitudinal diameter, as described in anatomy books; it is possible to segment IJV into three different segments J3 to J1, as it proposed in ultrasound US studies and CT scan. In this review, the morphology and methodology of the cerebral venous drainage through IJV are presented.

Internal jugular veins (IJVs) are the largest veins in the neck and are considered the primary cerebral venous drain for the intracranial blood in supine position. Any reduction in their flow could potentially results an increase in cerebral blood volume and intracranial pressure (ICP). The right internal jugular vein communicates with the right atrium via the superior vena cava, in which a functional valve is located at the union of the internal jugular vein and the superior vena cava. The atrium aspiration is the main mechanism governing the rhythmic leaflets movement of internal jugular vein valve synchronizing with the cardiac cycle. Cardiac contractions and intrathoracic pressure changes are reflecting in Doppler spectrum of the internal jugular vein. The evaluation of the jugular venous pulse provides valuable information about cardiac hemodynamics and cardiac filling pressures. The normal jugular venous pulse wave consists of three positive waves, a, c, and v, and two negative waves, x and y. A normal jugular vein gradually reduces its longitudinal diameter, as described in anatomy books; it is possible to segment IJV into three different segments J3 to J1, as it proposed in ultrasound US studies and CT scan. In this review, the morphology and methodology of the cerebral venous drainage through IJV are presented. [ABSTRACT FROM AUTHOR]

(1) Background: internal jugular vein thrombosis (IJVthr) is a potentially life-threating disease but no comprehensive reviews on etiology, symptomatology, diagnosis and current treatment guidelines are yet available; (2) Methods: we prospectively developed a protocol that defined objectives, search strategy for study identification, criteria for study selection, data extraction, study outcomes, and statistical methodology, according to the PRISMA standard. We performed a computerized search of English-language publications listed in the various electronic databases. We also retrieved relevant reports from other sources, especially by the means of hand search in the Glauco Bassi Library of the University of Ferrara; (3) Results: using the predefined search strategy, we retrieved and screened 1490 titles. Data from randomized control trials were few and limited to the central vein catheterization and to the IJVthr anticoagulation treatment. Systematic reviews were found just for Lemierre syndrome, the risk of pulmonary embolism, and the IJVthr following catheterization. The majority of the information required in our pre-defined objectives comes from perspectives observational studies and case reports. The methodological quality of the included studies was from moderate to good. After title and abstract evaluation, 1251 papers were excluded, leaving 239 manuscripts available. Finally, just 123 studies were eligible for inclusion. We found out the description of 30 different signs, symptoms, and blood biomarkers related to this condition, as well as 24 different reported causes of IJVthr. (4) Conclusions: IJVthr is often an underestimated clinical problem despite being one of the major sources of pulmonary embolism as well as a potential cause of stroke in the case of the upward propagation of the thrombus. More common symptoms are neck pain and headache, whereas swelling, erythema and the palpable cord sign beneath the sternocleidomastoid muscle, frequently associated with fever, are the most reported clinical signs. An ultrasound of the neck, even limited to the simple and rapid assessment of the compression maneuver, is a quick, economic, cost-effective, noninvasive tool. High quality studies are currently lacking.

Background: Cerebral venous drainage might influence brain edema characteristics and functional outcome of patients with severe ischemic stroke. The purpose of the study was to evaluate whether hypoplasia of transverse sinuses or the internal jugular veins is associated with poor functional outcome in patients with space-occupying middle cerebral artery (MCA) infarction who underwent decompressive surgery.Methods: We performed a retrospective analysis of patients with space-occupying MCA infarction treated with decompressive surgery at our university hospital. The transverse sinuses and the internal jugular veins were evaluated on baseline images and categorized as normal, hypoplastic or occluded. We defined composite variables for ipsilateral, contralateral or any abnormal cerebral venous drainage. We assessed the functional outcome at 12 months with the modified Rankin scale (mRS) score and defined poor functional outcome as mRS scores 5 and 6.Results: We analyzed 88 patients with available baseline imaging data [mean [SD] patient age 53 (±9) years; median[IQR] time to decompressive surgery 31(22-51) h]. At 12 months 44 patients (50%) had a poor outcome. In univariate analysis neither ipsilateral (OR 1.98;95%CI: 0.75–5.40), nor contralateral (OR 1.56;95%CI: 0.59–4.24) or any (OR 1.6; 95%CI: 0.68–3.79) hypoplasia or occlusion of venous drainage were significantly associated with poor functional outcome. In multivariate analyses, higher patient age (OR 1.07;95%CI 1.01–1.14) and baseline stroke severity (OR 3.42;95%CI 1.31–9.40) were independent predictors of poor functional outcome, but not ipsilateral hypoplasia or occlusion of venous drainage (OR 1.31;95%CI 0.47–3.67).Conclusions: The cerebral venous drainage pattern was not significantly associated with poor functional outcome in our cohort of patients with space-occupying MCA infarction who underwent decompressive surgery.

Background: Cerebral venous drainage might influence brain edema characteristics and functional outcome of patients with severe ischemic stroke. The purpose of the study was to evaluate whether hypoplasia of transverse sinuses or the internal jugular veins is associated with poor functional outcome in patients with space-occupying middle cerebral artery (MCA) infarction who underwent decompressive surgery. Methods: We performed a retrospective analysis of patients with space-occupying MCA infarction treated with decompressive surgery at our university hospital. The transverse sinuses and the internal jugular veins were evaluated on baseline images and categorized as normal, hypoplastic or occluded. We defined composite variables for ipsilateral, contralateral or any abnormal cerebral venous drainage. We assessed the functional outcome at 12 months with the modified Rankin scale (mRS) score and defined poor functional outcome as mRS scores 5 and 6. Results: We analyzed 88 patients with available baseline imaging data [mean [SD] patient age 53 (±9) years; median[IQR] time to decompressive surgery 31(22-51) h]. At 12 months 44 patients (50%) had a poor outcome. In univariate analysis neither ipsilateral (OR 1.98;95%CI: 0.75–5.40), nor contralateral (OR 1.56;95%CI: 0.59–4.24) or any (OR 1.6; 95%CI: 0.68–3.79) hypoplasia or occlusion of venous drainage were significantly associated with poor functional outcome. In multivariate analyses, higher patient age (OR 1.07;95%CI 1.01–1.14) and baseline stroke severity (OR 3.42;95%CI 1.31–9.40) were independent predictors of poor functional outcome, but not ipsilateral hypoplasia or occlusion of venous drainage (OR 1.31;95%CI 0.47–3.67). Conclusions: The cerebral venous drainage pattern was not significantly associated with poor functional outcome in our cohort of patients with space-occupying MCA infarction who underwent decompressive surgery. [ABSTRACT FROM AUTHOR]

Ménière’s disease (MD) is a pathology of the inner ear, the symptoms of which include tinnitus, vertigo attacks, fluctuating hearing loss, and nausea. Neither cause nor cure are currently known, though animal experiments suggest that disruption of the inner ear circulation, including venous hypertension and endolymphatic hydrops, to be hallmarks of the disease. Recent evidence for humans suggests a potential link to strictures in the extracranial venous outflow routes. The purpose of the present work is to demonstrate that the inner-ear circulation in humans is disrupted by extracranial venous outflow stricture and to discuss the implications of this finding for MD. The hypothesis linking extracranial venous outflow strictures to the altered dynamics of central nervous system (CNS) fluid compartments is investigated theoretically via a global, closed-loop, multiscale mathematical model for the entire human circulation, interacting with the brain parenchyma and cerebrospinal fluid (CSF). The fluid dynamics model for the full human body includes submodels for the heart, pulmonary circulation, arterial system, microvasculature, venous system and the CSF, with a specially refined description of the inner ear vasculature. We demonstrate that extracranial venous outflow strictures disrupt inner ear circulation, and more generally, alter the dynamics of fluid compartments in the whole CNS. Specifically, as compared to a healthy control, the computational results from our model show that subjects with extracranial outflow venous strictures exhibit: altered inner ear circulation, redirection of flow to collaterals, increased intracranial venous pressure and increased intracranial pressure. Our findings are consistent with recent clinical evidence in humans that links extracranial outflow venous strictures to MD, aid the mechanistic understanding of the underlying features of the disease and lend support to recently proposed biophysically motivated therapies aimed at reducing the overall pressure in the inner ear circulation. More work is required to understand the finer details of the condition, such as the associated dynamics of fluids in the perilymphatic and endolymphatic spaces, so as to incorporate such knowledge into the mathematical models in order to reflect the real physiology more closely.

Idiopathic normal pressure hydrocephalus (iNPH) is a highly prevalent condition in the elderly population; however, the underlying pathophysiology in relation to the aging process remains unclear. To investigate the effect of removal of cerebrospinal fluid by lumbar “tap test” on the cerebral circulation in patients with iNPH, 14 patients with “probable” iNPH were studied using a novel blood tracking technique based on blood oxygenation level-dependent (BOLD) magnetic resonance signal intensity. By tracking the propagation of the low-frequency component of the BOLD signal, extended venous drainage times were observed in the periventricular region of the patients, which was reversed by tap test. Interestingly, the venous drainage time in the periventricular region exhibited an age-related prolongation in the healthy control group. Additional regression analyses involving 81 control subjects revealed a dissociation of deep and superficial venous systems with increasing age, presumably reflecting focal inefficiency in the deep system. Our results not only provide insights into the etiology of iNPH, but also point to a potential non-invasive biomarker for screening iNPH.

Ménière's disease (MD) is a pathology of the inner ear, the symptoms of which include tinnitus, vertigo attacks, fluctuating hearing loss, and nausea. Neither cause nor cure are currently known, though animal experiments suggest that disruption of the inner ear circulation, including venous hypertension and endolymphatic hydrops, to be hallmarks of the disease. Recent evidence for humans suggests a potential link to strictures in the extracranial venous outflow routes. The purpose of the present work is to demonstrate that the inner-ear circulation in humans is disrupted by extracranial venous outflow stricture and to discuss the implications of this finding for MD. The hypothesis linking extracranial venous outflow strictures to the altered dynamics of central nervous system (CNS) fluid compartments is investigated theoretically via a global, closed-loop, multiscale mathematical model for the entire human circulation, interacting with the brain parenchyma and cerebrospinal fluid (CSF). The fluid dynamics model for the full human body includes submodels for the heart, pulmonary circulation, arterial system, microvasculature, venous system and the CSF, with a specially refined description of the inner ear vasculature. We demonstrate that extracranial venous outflow strictures disrupt inner ear circulation, and more generally, alter the dynamics of fluid compartments in the whole CNS. Specifically, as compared to a healthy control, the computational results from our model show that subjects with extracranial outflow venous strictures exhibit: altered inner ear circulation, redirection of flow to collaterals, increased intracranial venous pressure and increased intracranial pressure. Our findings are consistent with recent clinical evidence in humans that links extracranial outflow venous strictures to MD, aid the mechanistic understanding of the underlying features of the disease and lend support to recently proposed biophysically motivated therapies aimed at reducing the overall pressure in the inner ear circulation. More work is required to understand the finer details of the condition, such as the associated dynamics of fluids in the perilymphatic and endolymphatic spaces, so as to incorporate such knowledge into the mathematical models in order to reflect the real physiology more closely. [ABSTRACT FROM AUTHOR]

Pediatric dural arteriovenous shunts (dAVSs) are a rare form of vascular disease: Fewer than 100 cases are reported in PubMed and the understanding of pediatric dAVS is limited. For this study, we searched in PubMed, reviewed and summarized the literature related to pediatric dAVSs. Our review revealed that pediatric dAVSs have an unfavorable natural history: If left untreated, the majority of pediatric dAVSs deteriorate. In a widely accepted classification scheme developed by Lasjaunias et al., pediatric dAVSs are divided into three types: Dural sinus malformation (DMS) with dAVS, infantile dAVS (IDAVS) and adult-type dAVS (ADAVS). In general, the clinical manifestations of dAVS can be summarized as having symptoms due to high-flow arteriovenous shunts, symptoms from retrograde venous drainage, symptoms from cavernous sinus involvement and hydrocephalus, among other signs and symptoms. The pediatric dAVSs may be identified with several imaging techniques; however, the gold standard is digital subtraction angiography (DSA), which indicates unique anatomical details and hemodynamic features. Effectively treating pediatric dAVS is difficult and the prognosis is often unsatisfactory. Transarterial embolization with liquid embolic agents and coils is the treatment of choice for the safe stabilization and/or improvement of the symptoms of pediatric dAVS. In some cases, transumbilical arterial and transvenous approaches have been effective, and surgical resection is also an effective alternative in some cases. Nevertheless, pediatric dAVS can have an unsatisfactory prognosis, even when timely and appropriate treatment is administered; however, with the development of embolization materials and techniques, the potential for improved treatments and prognoses is increasing. [ABSTRACT FROM AUTHOR]

In this review, the impact of restricted cerebral venous outflow on the biomechanics of the intracranial fluid system is investigated. The cerebral venous drainage system is often viewed simply as a series of collecting vessels channeling blood back to the heart. However there is growing evidence that it plays an important role in regulating the intracranial fluid system. In particular, there appears to be a link between increased cerebrospinal fluid (CSF) pulsatility in the Aqueduct of Sylvius and constricted venous outflow. Constricted venous outflow also appears to inhibit absorption of CSF into the superior sagittal sinus. The compliance of the cortical bridging veins appears to be critical to the behaviour of the intracranial fluid system, with abnormalities at this location implicated in normal pressure hydrocephalus. The compliance associated with these vessels appears to be functional in nature and dependent on the free egress of blood out of the cranium via the extracranial venous drainage pathways. Because constricted venous outflow appears to be linked with increased aqueductal CSF pulsatility, it suggests that inhibited venous blood outflow may be altering the compliance of the cortical bridging veins. [ABSTRACT FROM AUTHOR]

Abstract: Iron stores in the white and deep grey matter in course of multiple sclerosis (MS) have never been explained and could be related to abnormalities in venous drainage, but this possibility has never before been investigated. From an initial cohort of 320 subjects, after application of exclusion criteria, we selected 109 patients affected by MS, and 177 controls respectively composed by age- and sex-matched, healthy aged, and patients affected by other neurological diseases. They blindly underwent transcranial and extracranial Color–Doppler sonographic examination (TCCS-ECD), aimed at investigating five parameters related to normal cerebral venous outflow haemodynamics. Overall we analyzed 1430 TCSS-ECD parameters. In controls we found 861 normal parameters of cerebral venous return vs. 24 anomalous, whereas in MS 288 parameters were normal and 257 anomalous, respectively. Consequently, each of the considered Doppler haemodynamic parameters, when compared to revised McDonald criteria as a gold standard of MS diagnosis, showed separately a highly significant sensitivity and a noteworthy specificity. However, the detection ≥2 parameters in the same subject, never observed in controls, perfectly overlapped the diagnosis of MS (value, 95%CI: sensitivity 100%, 97–100; specificity 100%, 98–100; positive predictive value 100%, 97–100, negative predictive value 100%, 98–100; p <0.0001). Moreover, this study demonstrates a significant impairment of cerebral venous drainage in patients affected by MS, a mechanism potentially related to increased iron stores. [Copyright &y& Elsevier]

The internal jugular veins are considered to be the main pathways of cerebral blood drainage. However, angiographic and anatomical studies show a wide anatomical variability and varying degrees of jugular and non-jugular venous drainage. The study systematically analyses the types and prevalence of human cerebral venous outflow patterns by ultrasound and MRI. Fifty healthy volunteers (21 females; 29 males; mean age 27±7 years) were studied by color-coded duplex sonography. Venous blood volume flow was measured in both internal jugular and vertebral veins in the supine position. Furthermore, the global arterial cerebral blood volume flow was calculated as the sum of volume flows in both internal carotid and vertebral arteries. Three types of venous drainage patterns were defined: a total jugular volume flow of more than 2/3 (type 1), between 1/3 and 2/3 (type 2) and less than 1/3 (type 3) of the global arterial blood flow. 2D TOF MR-venography was performed exemplarily in one subject with type-1 and in two subjects with type-3 drainage. Type-1 drainage was present in 36 subjects (72%), type 2 in 11 subjects (22%) and type 3 in 3 subjects (6%). In the majority of subjects in our study population, the internal jugular veins were indeed the main drainage vessels in the supine body position. However, a predominantly non-jugular drainage pattern was found in approximately 6% of subjects. [ABSTRACT FROM AUTHOR]

The normal course and appearance of the veins draining the tectum mesencephali proper are described in detail on the basis of the anatomical radiological study. These specific veins, the quadrigeminal veins, were constantly present on autopsy study. There are two types of variations of these quadrigeminal veins. They have a close anatomical and angiographic correlation with the quadrigeminal plate proper, and also outline the posterior aspects of the quadrigeminal plate. The whole structure of the mesencephalon may be delineated by these veins in combination with the other veins of the mesencephalon. They may be of diagnostic value in the early recognition of the brain stem lesions. [ABSTRACT FROM AUTHOR]

The authors describe the angio-architecture of intracranial vascular malformations. Several patterns can be identified thanks to the intracranial superselective angiograms that can now be performed. Schematically, the following features can be seen: 1. Direct arterial supply, 2. Indirect arterial supply, 3. Flow-related arterial ectasia (aneurysm), 4. Dysplastic aneurysm, 5. Direct arteriovenous fistula, 6. Intralesional arterial ectasia (aneurysm), 7. Intralesional venous ectasia (aneurysm), 8. Venous ectasia. Each of these elementary arrangements are illustrated and their clinical significance outlined whenever possible. Finally, the dural AVM drainage into the cortical venous system serves as an almost experimental model for the appreciation of the role played by the venous congestive phenomenon in brain AVM symptoms. [ABSTRACT FROM AUTHOR]

(1) Background: internal jugular vein thrombosis (IJVthr) is a potentially life-threating disease but no comprehensive reviews on etiology, symptomatology, diagnosis and current treatment guidelines are yet available; (2) Methods: we prospectively developed a protocol that defined objectives, search strategy for study identification, criteria for study selection, data extraction, study outcomes, and statistical methodology, according to the PRISMA standard. We performed a computerized search of English-language publications listed in the various electronic databases. We also retrieved relevant reports from other sources, especially by the means of hand search in the Glauco Bassi Library of the University of Ferrara; (3) Results: using the predefined search strategy, we retrieved and screened 1490 titles. Data from randomized control trials were few and limited to the central vein catheterization and to the IJVthr anticoagulation treatment. Systematic reviews were found just for Lemierre syndrome, the risk of pulmonary embolism, and the IJVthr following catheterization. The majority of the information required in our pre-defined objectives comes from perspectives observational studies and case reports. The methodological quality of the included studies was from moderate to good. After title and abstract evaluation, 1251 papers were excluded, leaving 239 manuscripts available. Finally, just 123 studies were eligible for inclusion. We found out the description of 30 different signs, symptoms, and blood biomarkers related to this condition, as well as 24 different reported causes of IJVthr. (4) Conclusions: IJVthr is often an underestimated clinical problem despite being one of the major sources of pulmonary embolism as well as a potential cause of stroke in the case of the upward propagation of the thrombus. More common symptoms are neck pain and headache, whereas swelling, erythema and the palpable cord sign beneath the sternocleidomastoid muscle, frequently associated with fever, are the most reported clinical signs. An ultrasound of the neck, even limited to the simple and rapid assessment of the compression maneuver, is a quick, economic, cost-effective, noninvasive tool. High quality studies are currently lacking. [ABSTRACT FROM AUTHOR]

Objective: Current evidence suggests that intracranial dural arteriovenous fistulas (dAVFs) without cortical venous drainage (CVD) have a benign clinical course. However, no large study has evaluated the safety and efficacy of current treatments and their impact over the natural history of dAVFs without CVD., Methods: The authors conducted an analysis of the retrospectively collected multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database. Patient demographics and presenting symptoms, angiographic features of the dAVFs, and treatment outcomes of patients with Borden type I dAVFs were reviewed. Clinical and radiological follow-up information was assessed to determine rates of new intracranial hemorrhage (ICH) or nonhemorrhagic neurological deficit (NHND), worsening of venous hyperdynamic symptoms (VHSs), angiographic recurrence, and progression or spontaneous regression of dAVFs over time., Results: A total of 342 patients/Borden type I dAVFs were identified. The mean patient age was 58.1 ± 15.6 years, and 62% were women. The mean follow-up time was 37.7 ± 54.3 months. Of 230 (67.3%) treated dAVFs, 178 (77%) underwent mainly endovascular embolization, 11 (4.7%) radiosurgery alone, and 4 (1.7%) open surgery as the primary modality. After the first embolization, most dAVFs (47.2%) achieved only partial reduction in early venous filling. Multiple complementary interventions increased complete obliteration rates from 37.9% after first embolization to 46.7% after two or more embolizations, and 55.2% after combined radiosurgery and open surgery. Immediate postprocedural complications occurred in 35 dAVFs (15.2%) and 6 (2.6%) with permanent sequelae. Of 127 completely obliterated dAVFs by any therapeutic modality, 2 (1.6%) showed angiographic recurrence/recanalization at a mean of 34.2 months after treatment. Progression to Borden-Shucart type II or III was documented in 2.2% of patients and subsequent development of a new dAVF in 1.6%. Partial spontaneous regression was found in 22 (21.4%) of 103 nontreated dAVFs. Multivariate Cox regression analysis demonstrated that older age, NHND, or severe venous-hyperdynamic symptoms at presentation and infratentorial location were associated with worse prognosis. Kaplan-Meier curves showed no significant difference for stable/improved symptoms survival probability in treated versus nontreated dAVFs. However, estimated survival times showed better trends for treated dAVFs compared with nontreated dAVFs (288.1 months vs 151.1 months, log-rank p = 0.28). This difference was statistically significant for treated dAVFs with 100% occlusion (394 months, log-rank p < 0.001)., Conclusions: Current therapeutic modalities for management of dAVFs without CVD may provide better symptom control when complete angiographic occlusion is achieved.

OBJECTIVE In addition to craniocerebral disproportion, other factors, such as Chiari malformation type I, obstructive sleep apnea, and venous outflow obstruction, are considered to have a role in the occurrence of intracranial hypertension in craniosynostosis. This pilot study examined cerebral venous flow velocity to better characterize the complex intracranial venous physiology of craniosynostosis. METHODS The authors performed a prospective cohort study of craniosynostosis patients (n = 34) referred to a single national (tertiary) craniofacial unit. Controls (n = 28) consisted of children who were referred to the unit's outpatient clinic and did not have craniosynostosis. Transfontanelle ultrasound scans with venous Doppler flow velocity assessment were performed at the first outpatient clinic visit and after each surgery, if applicable. Mean venous blood flow velocities of the internal cerebral vein (ICV v ) and the superior sagittal sinus (SSS v ) were recorded and blood flow waveform was scored. RESULTS Preoperatively, SSS v was decreased in craniosynostosis patients compared with controls (7.57 vs 11.31 cm/sec, p = 0.009). ICV v did not differ significantly between patients and controls. Postoperatively, SSS v increased significantly (7.99 vs 10.66 cm/sec, p = 0.023). Blood flow waveform analyses did not differ significantly between patients and controls. CONCLUSIONS Premature closure of cranial sutures was associated with decreased SSS v but not ICV v ; indicating an effect on the superficial rather than deep venous drainage. Further Doppler ultrasound studies are needed to test the hypothesis that at an early stage of craniosynostosis pathology SSS v , but not pulsatility, is abnormal, and that abnormality in both SSS v and the superficial venous waveform reflect a more advanced stage of evolution in suture closure.

Background: Several studies using Doppler ultrasound have suggested cerebral venous drainage is through paravertebral venous plexus due to the collapse of internal jugular veins in an upright position., Methods: We present a technique of acquiring venographic images during an upright position as part of catheter-based angiography to provide additional information regarding cerebral venous diseases. Angiographic images in anteroposterior projection were acquired in lying position and after patients were placed at 60° using radiolucent supporting wedges on angiographic table., Results: In the first patient, there was activation of the paravertebral venous plexus as supplemental venous drainage to right internal jugular vein and stenosis of left internal jugular vein in high cervical segment in the upright position. There was relative collapse of both internal jugular veins in the mid-cervical region. In the second patient, there was attenuation of contrast opacification of right posterior cervical veins and complete occlusion of right internal jugular vein proximal extracranial segment (high-grade stenosis in lying position). There was activation of additional supplemental drainage to left internal jugular vein including paravertebral venous plexus. In the third patient, there was exacerbation of stenoses of the left and right internal jugular veins proximal extracranial segment in the upright position (moderate stenoses in lying position). There was activation of additional supplemental drainage via paravertebral venous plexus to both internal jugular veins., Conclusion: Our results demonstrate prominent changes in venous drainage patterns during upright angiographic images. Further studies would have to identify the patients in whom additional information in the upright angiography may provide clinically relevant information.

Abstract: Background: Cerebral arteriovenous fistula (AVF) is a rare disease. We present one adult with a deep cerebral AVF presented with cerebellar hemorrhage. Case description: A 35-year-old man suddenly experienced headache, vomiting, dysarthria and ataxia of gait. Computed tomography (CT) demonstrates bilateral cerebellar hemorrhage. Angiography revealed a cerebral AVF fed by the bilateral medial posterior choroidal arteries and drained into the supratentorial deep venous system with flow into the infratentorial venous system. The draining veins included three varices, one of which, in the cerebellar vermis, was thought to be the source of bleeding. The patient was treated with transarterial embolization using n-butyl-cyanoacrylate (NBCA) and detachable platinum coils. Although coil migration during endovascular treatment occurred, complete closure of the fistula without morbidity and mortality was obtained. Conclusion: Direct intracranial arteriovenous fistula with supra and infra tentorial venous drainage is rare; it can present with intracranial hemorrhage and can be treated by endovascular therapy. [Copyright &y& Elsevier]