Jugular Venous Reflux in Total Global Amnesia: Simultaneous TCD Bubble Test and Carotid/Jugular Duplex Examination

Abstract

PurposeWe report an unusual case of venous reflux in a patient with memory loss and focal deficits who was found with an unusual flow pattern on Transcranial Doppler bubble test (TCD-BT) where venous bubbles were found and later confirmed on carotid/jugular duplex (CJD) examination. While chronic Cerebral Spinal Venous Insufficiency (CCSVI) is now a fashionable finding in Multiple Sclerosis, other neurological disease should not be forgotten.Material & MethodsA 22-year-old male presented after multiple episodes of right-side weakness and memory loss associated with repetitive questioning during these episodes. The family also reported that the patient had episodes of isolated, transient memory problems that were not associated with weakness. TCD-BT was performed with 10cc agitated saline test in sitting position. TCD-BT test was performed in the supine position simultaneously with CJD.ResultsTCD-BT shows venous embolization but only minimal arterial embolization in the brain, which could be a potential pitfall for Patent Foramen Ovale (PFO) detection. Carotid/jugular duplex (CJD) examinations revealed cranial flow in the jugular vein during Valsalva maneuver.ConclusionJugular reflux is a poorly understood mechanism of cerebral dysfunction. Cerebral congestion caused by venous reflux is reported in total global amnesia (TGA), but this is the first report on TCD bubble test. CJD assisted with understanding the unusual TCD-BT finding might result in new applications for different neurological diseases. PurposeWe report an unusual case of venous reflux in a patient with memory loss and focal deficits who was found with an unusual flow pattern on Transcranial Doppler bubble test (TCD-BT) where venous bubbles were found and later confirmed on carotid/jugular duplex (CJD) examination. While chronic Cerebral Spinal Venous Insufficiency (CCSVI) is now a fashionable finding in Multiple Sclerosis, other neurological disease should not be forgotten. We report an unusual case of venous reflux in a patient with memory loss and focal deficits who was found with an unusual flow pattern on Transcranial Doppler bubble test (TCD-BT) where venous bubbles were found and later confirmed on carotid/jugular duplex (CJD) examination. While chronic Cerebral Spinal Venous Insufficiency (CCSVI) is now a fashionable finding in Multiple Sclerosis, other neurological disease should not be forgotten. Material & MethodsA 22-year-old male presented after multiple episodes of right-side weakness and memory loss associated with repetitive questioning during these episodes. The family also reported that the patient had episodes of isolated, transient memory problems that were not associated with weakness. TCD-BT was performed with 10cc agitated saline test in sitting position. TCD-BT test was performed in the supine position simultaneously with CJD. A 22-year-old male presented after multiple episodes of right-side weakness and memory loss associated with repetitive questioning during these episodes. The family also reported that the patient had episodes of isolated, transient memory problems that were not associated with weakness. TCD-BT was performed with 10cc agitated saline test in sitting position. TCD-BT test was performed in the supine position simultaneously with CJD. ResultsTCD-BT shows venous embolization but only minimal arterial embolization in the brain, which could be a potential pitfall for Patent Foramen Ovale (PFO) detection. Carotid/jugular duplex (CJD) examinations revealed cranial flow in the jugular vein during Valsalva maneuver. TCD-BT shows venous embolization but only minimal arterial embolization in the brain, which could be a potential pitfall for Patent Foramen Ovale (PFO) detection. Carotid/jugular duplex (CJD) examinations revealed cranial flow in the jugular vein during Valsalva maneuver. ConclusionJugular reflux is a poorly understood mechanism of cerebral dysfunction. Cerebral congestion caused by venous reflux is reported in total global amnesia (TGA), but this is the first report on TCD bubble test. CJD assisted with understanding the unusual TCD-BT finding might result in new applications for different neurological diseases. Jugular reflux is a poorly understood mechanism of cerebral dysfunction. Cerebral congestion caused by venous reflux is reported in total global amnesia (TGA), but this is the first report on TCD bubble test. CJD assisted with understanding the unusual TCD-BT finding might result in new applications for different neurological diseases.