Diagnostic pitfall: Atypical cerebral venous drainage via the vertebral venous system

Department of Neurology, University Hospital Charité, Humboldt University, Berlin, Germany.
American Journal of Neuroradiology (Impact Factor: 3.59). 04/2002; 23(3):408-11.
Source: PubMed


We report a case of atypical cerebral venous drainage in a 38-year-old woman with symptoms of benign paroxysmal positional vertigo. Thrombosis of the left internal jugular vein and sigmoid sinus was suspected on the basis of spin-echo and time-of-flight MR findings, but multisection CT angiograms showed a patent sigmoid sinus and predominant drainage via the emissary veins toward the vertebral plexus, with only a minor contribution of the jugular veins. This case illustrates the variability of the venous anatomy in the craniocervical region.

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    • "CT angiography is a valuable tool for assessing the emissary veins and venous vascular canals. It is superior to MR venography in depicting venous structures with slower flow and smaller diameters.[7] It also has the advantage of imaging the bony canal. "
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    ABSTRACT: Purpose: We assessed the prevalence of the clinically important posterior fossa emissary veins detected on computed tomography (CT) angiography. Materials and Methods: A total of 182 consecutive patients who underwent 64-slice CT angiography were retrospectively reviewed to determine the clinically important posterior fossa emissary veins. Results: Of 166 patients, the mastoid emissary vein (MEV) was not identified in 37 (22.3%) patients. It was found bilaterally in 82 (49.4%) and unilaterally in 47 (28.3%) patients. Only six patients had more than one MEV that were very small (<2 mm), and only five patients had very large (>5 mm) veins. The posterior condylar vein (PCV) was not identified in 39 (23.5%) patients. It was found bilaterally in 97 (58.4%) and unilaterally in 30 (18.1%) patients. Only 15 patients had a very large (>5 mm) PCV. The petrosquamosal sinus (PSS) was identified only in one patient (0.6%) on the left side. The occipital sinus was found in two patients (1.2%). Conclusions: The presence of the clinically important posterior fossa emissary veins is not rare. Posterior fossa emissary veins should be identified and systematically reported, especially prior to surgeries involving the posterior fossa and mastoid region.
    04/2014; 5(2):135-8. DOI:10.4103/0976-3147.131654
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    • "An MEV is an embryonic residual venous tract that connects the sigmoid sinus and extracranial venous system, and may serve as an exit route for diploic venous blood (6). An MEV can become dilated by high-flow vascular malformations or when associated with severely hypoplastic jugular veins (7). In our case, however, we observed only a dilated MEV, with no other vascular abnormality seen in the posterior fossa or jugular venous system. "
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    ABSTRACT: Although pulsatile tinnitus can be audible, objective demonstration of this heartbeat-synchronous sound has rarely been successful. We report a rare case of pulsatile tinnitus in a 44-yr-old female patient, which was induced by a large mastoid emissary vein (MEV) and objectively documented by Doppler sonography of the left posterior auricular region. The tinnitus was intermittent and the patient could adapt to the tinnitus without intervention on the mastoid emissary vein. These findings suggest that a single large MEV can cause pulsatile tinnitus in the absence of other vascular abnormalities, and imaging studies of the posterior fossa and Doppler ultrasonography can aid the diagnosis in such cases.
    Journal of Korean medical science 04/2013; 28(4):628-30. DOI:10.3346/jkms.2013.28.4.628 · 1.27 Impact Factor
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    • "A dorsal part is connected to suboccipital venous plexus, which receives blood through mastoid and condylar emissaries (Schaller, 2004; Brew, 2004). Although the jugular veins were previously thought to be the predominant draining pathway (Cowan et al., 1983), anatomical recent study-findings have demonstrated that this role is confined to the supine position; redirection of venous flow to the vertebral veins occurs in upright-position (Schaller et al., 2004; Schreiber et al. 2003; Hoffmann et al., 2002). The vertebral veins (VVs) are Part of the vertebral system, which have been shown to serve as venous collaterals in cases of jugular flow obstruction (Schreiber et al., 2003). "
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    ABSTRACT: A new nosologic vascular pattern that is defined by chronic cerebrospinal venous insufficiency (CCSVI) has been strongly associated with multiple sclerosis. The picture is characterized by significant obstacles of the main extracranial cerebrospinal veins, the jugular and the azygous system, and by the opening of substitute circles. The significance of collateral circle is still neglected. To the contrary, substitute circles are alternative pathways or vicarious venous shunts, which permit the drainage and prevent intracranial hypertension. In accordance with the pattern of obstruction, even the intracranial and the intrarachidian veins can also become substitute circles; they permit redirection of the deviated flow, piping the blood toward available venous segments outside the central nervous system. We review the complex gross and radiological anatomy of collateral circulation found activated by the means of EchoColor-Doppler and selective venography in the event of CCSVI, focusing particularly on the suboccipital cavernous sinus (SCS), the condylar venous system, the pterygoid plexus, the thyroid veins, and the emiazygous-lumbar venous anastomosis with the left renal vein.
    Current neurovascular research 09/2009; 6(3):204-12. DOI:10.2174/156720209788970054 · 2.25 Impact Factor
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