Cerebral Congestion Research Articles

COMPARATIVE ANALYSIS OF COMPLEX INFORMATION SYSTEM TESTING METHODS


 
 
 
 The research has been based on surgical experience of multiple decades and on retrospect study of more that 4000 clinical cases, among them 3500 surgical invasion due to different types of traumas. Since it relies on the latter, it shows the evolution of our approaches towards severe cerebral cranial traumon includes different matters regarding diagnostics and surgical treatment with neuropathogenetic approach. We have shown the advantages of certain surgical procedures in cases of cerebral cranial trauma and also the way approaches were changing after introduction of high medical technology and taking into consideration bio mechanisms and pathological data. Computer diagnostics changed several surgical procedures and opportunities. In cases of traumas impacted in immobilized condition method of choice used to be plastic craniotomy, when in cases of cerebral congestion would cause decompression, placing bone fragment under the skin. 902 surgeries were performed among 1990. In 894 cases surgeries were performed using plastic trepanation, 217 among them was performed with improved modified method. In cases of negligible brain congestion, bone fragment was left in its place without suture fixation and after the congestion resolution fragment would return to its anatomical location. In several times it would be ligated in 2-3 points. This method was the most efficient in bi-frontal low craniotomy. The need of removing bone fragment was observed in zero cases.
 In cases of acceleration traumas, which is characterized by diffuse damage, multifocal hemorrhages and bruises, in 157 cases double decompression method was used, in some case with falcostomy, effective in 49 cases. Trafination and resection trepanation were removed from practice.
 Trafination method was sometimes use in cases of chronic hematomas and acute hydromas. In Recurrent and chronic hydromas method was less effective, in such conditions plastic trepanation method was used in order to create extra space for fluid. In singular cases of collapsed brain and for resolving tunica arachnoidea broken surface, we used to infuse 25-35 cubic oxygen or 20-25 distillate in spinal cord. This method was proved effective in 70 cases. Therefore, taking into consideration patho-mechanisms and pathology data, using differential pathogenetic methods of surgical invasion and computer monitoring of post-operative period we managed to decrease mortality in severecerebro-cranial traumas to 29-30% comparing to pre computer periods 36-38 % and comparing to data of other clinics 35-45%.
 
 
 

Cognitive impairment in heart failure patients: association with abnormal circadian blood pressure rhythm: a review from the HOPE Asia Network.

Cognitive impairment (CI) is frequently a comorbid condition in heart failure (HF) patients, and is associated with increased cardiovascular events and death. Numerous factors contribute to CI in HF patients. Decreased cerebral blood flow, inflammation, and activation of neurohumoral factors are all thought to be factors that exacerbate CI. Hypoperfusion of the brain due to decreased systemic blood flow, cerebral venous congestion, and atherosclerosis are the main mechanism of CI in HF patients. Abnormal circadian BP rhythm is one of the other conditions associated with CI. The conditions in which BP does not decrease sufficiently or increases during the night are called non-dipper or riser BP patterns. Abnormal circadian BP rhythm worsens CI in HF patients through cerebral congestion during sleep and atherosclerosis due to pressure overload. Interventions for CI in HF patients include treatment for HF itself using cardiovascular drugs, and treatment for fluid retention, one of the causes of abnormal circadian rhythms. Proposed pathways of cognitive impairment in heart failure through abnormal circadian blood pressure rhythm.

SELECTIVE, BIONEUROPATHOGENETIC APPROACH TO THE CHOICE OF INTERVENTION IN VARIOUS CLINICAL AND ANATOMICAL FORMS OF SEVERE TRAUMATIC BRAIN INJURY

The research has been based on surgical experience of multiple decades and on retrospect study of more that 4000 clinical cases, among them 3500 surgical invasion due to different types of traumas. Since it relies on the latter, it shows the evolution of our approaches towards severe cerebral cranial traumon includes different matters regarding diagnostics and surgical treatment with neuropathogenetic approach. We have shown the advantages of certain surgical procedures in cases of cerebral cranial trauma and also the way approaches were changing after introduction of high medical technology and taking into consideration bio mechanisms and pathological data. Computer diagnostics changed several surgical procedures and opportunities. In cases of traumas impacted in immobilized condition method of choice used to be plastic craniotomy, when in cases of cerebral congestion would cause decompression, placing bone fragment under the skin. 902 surgeries were performed among 1990. In 894 cases surgeries were performed using plastic trepanation, 217 among them was performed with improved modified method. In cases of negligible brain congestion, bone fragment was left in its place without suture fixation and after the congestion resolution fragment would return to its anatomical location. In several times it would be ligated in 2-3 points. This method was the most efficient in bi-frontal low craniotomy. The need of removing bone fragment was observed in zero cases. In cases of acceleration traumas, which is characterized by diffuse damage, multifocal hemorrhages and bruises, in 157 cases double decompression method was used, in some case with falcostomy, effective in 49 cases. Trafination and resection trepanation were removed from practice. Trafination method was sometimes use in cases of chronic hematomas and acute hydromas. In Recurrent and chronic hydromas method was less effective, in such conditions plastic trepanation method was used in order to create extra space for fluid. In singular cases of collapsed brain and for resolving tunica arachnoidea broken surface, we used to infuse 25-35 cubic oxygen or 20-25 distillate in spinal cord. This method was proved effective in 70 cases. Therefore, taking into consideration patho-mechanisms and pathology data, using differential pathogenetic methods of surgical invasion and computer monitoring of post-operative period we managed to decrease mortality in severecerebro-cranial traumas to 29-30% comparing to pre computer periods 36-38 % and comparing to data of other clinics 35-45%.

Exploration on the therapeutic ideas and applications of hypertension based on the academic thoughts of Zhang Xichun and Shi Jinmo in treating cerebral congestion

Exploration on the therapeutic ideas and applications of hypertension based on the academic thoughts of Zhang Xichun and Shi Jinmo in treating cerebral congestion

Early Detection and Correction of Cerebral Desaturation With Noninvasive Oxy-Hemoglobin, Deoxy-Hemoglobin, and Total Hemoglobin in Cardiac Surgery: A Case Series.

Regional cerebral oxygen saturation (rS o2 ) obtained from near-infrared spectroscopy (NIRS) provides valuable information during cardiac surgery. The rS o2 is calculated from the proportion of oxygenated to total hemoglobin in the cerebral vasculature. Root O3 cerebral oximetry (Masimo) allows for individual identification of changes in total (ΔcHbi), oxygenated (Δ o2 Hbi), and deoxygenated (ΔHHbi) hemoglobin spectral absorptions. Variations in these parameters from baseline help identify the underlying mechanisms of cerebral desaturation. This case series represents the first preliminary description of Δ o2 Hbi, ΔHHbi, and ΔcHbi variations in 10 cardiac surgical settings. Hemoglobin spectral absorption changes can be classified according to 3 distinct variations of cerebral desaturation. Reduced cerebral oxygen content or increased cerebral metabolism without major blood flow changes is reflected by decreased Δ o2 Hbi, unchanged ΔcHbi, and increased ΔHHbi Reduced cerebral arterial blood flow is suggested by decreased Δ o2 Hbi and ΔcHbi, with variable ΔHHbi. Finally, acute cerebral congestion may be suspected with increased ΔHHbi and ΔcHbi with unchanged Δ o2 Hbi. Cerebral desaturation can also result from mixed mechanisms reflected by variable combination of those 3 patterns. Normal cerebral saturation can occur, where reduced cerebral oxygen content such as anemia is balanced by a reduction in cerebral oxygen consumption such as during hypothermia. A summative algorithm using rS o2 , Δ o2 Hbi, ΔHHbi, and ΔcHbi is proposed. Further explorations involving more patients should be performed to establish the potential role and limitations of monitoring hemoglobin spectral absorption signals.

Electroencephalogram evaluation of accidental cerebral congestion during unexpected superior vena cava clamping: a case report

BackgroundIntraoperative superior vena cava (SVC) clamping causes hypotension and cerebral congestion. There is no established method for monitoring brain function during cerebral congestion. We encountered a case of cerebral congestion caused by unexpected SVC clamping.Case presentationA 64-year-old man underwent SVC clamping during lung tumor resection. The entropy and electroencephalogram monitoring values decreased with SVC clamping and increased in response to the release of congestion by phlebotomy and SVC declamping.ConclusionsBecause entropy sharply reflects brain viability during cerebral congestion, it was considered helpful in evaluation of the monitoring of cerebral congestion.

Experience of surgical treatment of patients with severe traumatic brain injury

The research has been based on surgical experience of multiple decades and on retrospect study of more that 4000 clinical cases, among them 3500 surgical invasion due to different types of traumas. Since it relies on the latter, it shows the evolution of our approaches towards severe cerebral cranial traumon includes different matters regarding diagnostics and surgical treatment with neuropathogenetic approach. We have shown the advantages of certain surgical procedures in cases of cerebral cranial trauma and also the way approaches were changing after introduction of high medical technology and taking into consideration bio mechanisms and pathological data.Computer diagnostics changed several surgical procedures and opportunities. In cases of traumas impacted in immobilized condition method of choice used to be plastic craniotomy, when in cases of cerebral congestion would cause decompression, placing bone fragment under the skin. 902 surgeries were performed among 1990. In 894 cases surgeries were performed using plastic trepanation, 217 among them was performed with improved modified method. In cases of negligible brain congestion, bone fragment were left in its place without suture fixation and after the congestion resolution fragment would return to its anatomical location. In several times it would be ligated in two – three points.This method was the most efficient in bifrontal low craniotomy. The need of removing bone fragment was observed in zero cases.In cases of acceleration traumas, which is characterized by diffuse damage, multifocal hemorrhages and bruises, in 157 cases double decompression method was used, in some case with falcostomy, effective in 49 cases. Trafination and resection trepanation were removed from practice.Trafination method was sometimes use in cases of chronic hematomas and acute hydromas. In Recurrent and chronic hydromas method was less effective, in such conditions plastic trepanation method was used in order to create extra space for fluid. In singular cases of collapsed brain and for resolving tunica arachnoidea broken surface, we used to infuse 25–35 ml oxygen or 20–25 ml distillate in spinal chord. This method was proved effective in 70 cases.Therefore, taking into consideration patho-mechanisms and pathology data, using differential pathogenetic methods of surgical invasion and computer monitoring of post-operative period we managed to decrease mortality in severecerebro- cranial traumas to 29–30 % comparing to pre computer periods 36–38 %.

Influence of age on the pathology of hippocampus and variation in the number of neurons of the hilar region in the brain of dogs

Brain is a vital organ that always has high oxygen demands and is highly vulnerable to injury caused by reactive oxygen species (ROS). The hippocampus is a complex structure seen deep in the temporal lobe which is constituted by the dentate gyrus, hippocampus proper (Cornu Ammonis- CA1-CA4) and subiculum. The important functions of the hippocampus are learning and memory. Age-influenced pathological lesions in the hippocampus and variation in the number of neurons in the hilus are the main discussion of this study. The major gross lesions observed in the brain of both younger and older dogs were cerebral congestion, thickened meninges and cerebral edema. The major histopathological findings in the hippocampus were thickened blood vessels, accumulation of lipofuscin pigments in the neuronal cytoplasm, satellitosis, gliosis, neurons with the vesicular nucleus, chromatolysis and neuronophagia. A statistically significant reduction in the number of neurons in the hilar region of the hippocampus was observed in aged dogs.

Pathological and Molecular Studies on Diagnosis of Infectious Bovine Abortions

Bovine abortions have a multifactorial aetiology involving bacterial, viral, fungal and protozoan agents. In the present study, gross pathological, histopathological and polymerase chain reaction (PCR) technique(s) have been applied for diagnosis of infectious abortion in bovine. Histopathology was used as a reference technique to support the confirmation by PCR. Aborted bovine fetuses (n=31) of various gestational age and placenta (n=11) of aborted dam were or infectious diseases screened, which includes Neospora caninum, Brucella abortus, To/oplasma gondii and Infectious bovine rhinotracheitis virus. Gross lesions observed in aborted foetuses were serosanguineous fluid in the thoracic cavity, congestion of cerebrum, heart, liver and lungs. Lesions such as cerebral congestion with non-suppurative encephalitis, perivascular cuffing and Purkinje cell layer degeneration of brain, exfoliation of placental chorionic epithelium along with severe lymphomonocytic cell infiltrations were observed histopathologically. Eosinophilic intranuclear inclusions were observed in two placental tissues using routine H&E staining and special staining for inclusion bodies. PCR showed amplification of gene for the existence of N. caninum (1/31), Brucella (7/31) and BHV-1 (2/31) in the stomach content of aborted foetuses.

First Isolation and Molecular Characterization of Pseudorabies Virus in a Hunting Dog in Sicily (Southern Italy)

Pseudorabies virus (PrV) is the etiological agent of Aujeszky’s disease, a viral infection that causes neurological lethal illness in mammals other than swine. Herein, we describe the occurrence of PrV infection in a hunting dog that had been bitten by an infected wild boar in Sicily, reporting for the first time genetic and phylogenetic data on the virus strain isolated in a dog in this Italian region. The dog was referred for severe neurological signs, respiratory distress, and intense itch around the muzzle. Death occurred within 48 h to the onset of clinical signs. On gross examination, self-induced skin lesions to the head due to intense itching and diffuse cerebral congestion were observed, whereas mild, aspecific, nonsuppurative meningitis was histologically diagnosed. Diffuse PrV positivity in neurons of the brainstem was observed by immunohistochemistry. PrV DNA was isolated and amplified from olfactory bulbs by nested PCR, targeting the viral glycoprotein G gene, and the sequence obtained matched with sequences of PrV isolates from dogs and wild boar. Isolation of PrV in the dog herein analysed denotes the spread of the virus in wild boar populations in Sicily and provides a proof of direct interspecies transmission. Thus, there is an urgent need to increase our understanding of the epidemiology of the PrV infection in wildlife to provide tools to trace possible spill over into domestic pigs or other livestock.

Disorders in blood circulation as a probable cause of death in dogs infected with Babesia canis

IntroductionThe purpose of the study was to investigate post-mortem changes in dogs infected with Babesia canis and to establish the probable cause of death of the affected animals.Material and MethodsCadavers of six dogs that did not survive babesiosis were collected. Necropsies were performed and samples of various organs were collected for histological examination.ResultsNecropsies and histological examinations revealed congestion and oedemata in various organs. Most of the dogs had ascites, hydrothorax or hydropericardium, pulmonary oedema, pulmonary, renal, hepatic, and cerebral congestion, and necrosis of cardiomyocytes.ConclusionThese results suggested disorders in blood circulation as the most probable cause of death. However, the pulmonary inflammatory response and cerebral babesiosis observed in some of these dogs could also be considered possible causes of death. This study also showed a possible role for renal congestion in the development of renal hypoxia and azotaemia in canine babesiosis.

Prosper Menière: the man who located vertigo in the inner ear.

Since the Greek Aellus Galenum (129 AD - c.200/c.216), vertigo was considered a problem attributed to a cerebral disorder, diagnosed as the manifestation of apoplectiform cerebral congestion. In the mid-19th century, the Frenchman Prosper Menière changed this concept by placing the origin of this symptom in the inner ear. The main objective of this historical note is to highlight who Menière was, his work, and some aspects of the disease that bears his name.

Ventilatory response to hypercapnia is increased after 4\xa0h of head down bed rest

Head-down bed rest (HDBR) has previously been shown to alter cerebrovascular and autonomic control. Previous work found that sustained HDBR (≥ 20 days) attenuates the hypercapnic ventilatory response (HCVR); however, little is known about shorter-term effects of HDBR nor the influence of HDBR on the hypoxic ventilatory response (HVR). We investigated the effect of 4-h HDBR on HCVR and HVR and hypothesized attenuated ventilatory responses due to greater carotid and brain blood flow. Cardiorespiratory responses of young men (n = 11) and women (n = 3) to 5% CO2 or 10% O2 before and after 4-h HDBR were examined. HDBR resulted in lower HR, lower cardiac output index, lower common carotid artery flow, higher SpO2, and higher pulse wave velocity. After HDBR, tidal volume and ventilation responses to 5% CO2 were enhanced (all P < 0.05), yet no other changes in cardiorespiratory variables were evident. There was no influence of HDBR on the cardiorespiratory responses to hypoxia (all P > 0.05). Short-duration HDBR does not alter the HVR, yet enhances the HCVR, which we hypothesize is a consequence of cephalic CO2 accumulation from cerebral congestion.

Apoplexy in Richard Bright’s (1789–1858) reports of medical cases

ABSTRACT This study examines Bright’s cases in the section on pressure in Volume II of his Reports of Medical Cases of intracranial hemorrhages, cerebral congestion, and the “effusion of serum,” which Bright regarded as causes of apoplexy. He arranged the cases of intracranial hemorrhages in such a way that it became possible to recognize the differences in the symptomatology of what is currently known as subarachnoid, subdural, and extradural bleeding and of intracerebral hemorrhages. The value of these reports rests mainly on the accurate documentation of the symptomatology of his cases and detailed autopsy reports, some accompanied by intricate illustrations. Bright’s contributions to the notion of cerebral localizations and accounts of neurological conditions that were new or not well known at the time enhance the merit of this part of his Reports.

Cómo abordar la preeclampsia en el momento actual

En la Antigua Grecia se creía que el cuerpo humano estaba constituido por cuatro tipos de humores y que el desbalance entre ellos llevaba a la enfermedad. La mujer era considerada más vulnerable de presentar dolencias, por tener una súper producción de sus fluidos y presentar un “útero errante” que podría irrumpir en sus diferentes órganos y llevarla aún a convulsionar durante el embarazo (1). Hipócrates el padre de la Medicina, pensaba que las convulsiones durante el embarazo se producían por congestión o por depleción sanguínea del cerebro (2).Durante la Edad Media dominaron las creencias religiosas. Se utilizaron amuletos, pociones mágicas y oraciones de sanidad (1). Para tratar de disminuir la congestión cerebral y prevenir la eclampsia, Mauriceau recomendó realizar de dos a tres flebotomías durante el embarazo y magnificó en sus escritos la naturaleza crítica de la enfermedad (3).Al final del siglo 19 y comienzo del 20, los médicos alemanes y de los países bajos realizaban un manejo agresivo de la eclampsia, desembarazando de manera inmediata por vía vaginal o abdominal. Esta conducta obstétrica agresiva incrementó de manera notable la mortalidad materna. Como resultado empezó a ganar popularidad el manejo conservador de la eclampsia (4). Los pioneros de este método fueron Tweedy de Dublin y Stroganoff de Rusia (1). El primero consideraba que el trabajo de parto incrementaba la ocurrencia de convulsiones por mecanismos reflejos. El médico debía abstenerse de realizar exámenes vaginales, palpación abdominal, dilatación del cérvix. La paciente debía sedarse con altas dosis de morfina. Si se entraba en trabajo de parto la aplicación del fórceps era aceptada (5).

Transient global amnesia: an uncommon presentation of acute myocardial infarction

Transient global amnesia (TGA) is an acute neurological syndrome characterized by sudden-onset global (anterograde and retrograde) amnesia, without compromising other neurological functions. This clinical condition lasts up to 24 h with whole restoration. Several causes have been proposed as responsible for it. Among these, acute myocardial infarction (AMI) was reported as a rare cause of TGA. Sympathetic hyperactivity occurring too early in AMI seems to induce vasospasm, responsible for venous cerebral congestion acting on hippocampal and temporal structures and consequent memory loss. A rare case of TGA as precocious display of subsequent AMI was described.

Is venous congestion associated with reduced cerebral oxygenation and worse neurological outcome after cardiac arrest?

BackgroundPost-cardiac arrest (CA) patients are at risk of secondary ischemic damage in the case of suboptimal brain oxygenation during an ICU stay. We hypothesized that elevated central venous pressures (CVP) would impair cerebral perfusion and oxygenation (venous cerebral congestion). The aim of the present study was to investigate the relationship between CVP, cerebral tissue oxygen saturation (SctO2) as assessed with near-infrared spectroscopy (NIRS) and outcome in post-CA patients.MethodsThis was an observational study in 48 post-CA patients with continuous CVP and SctO2 monitoring during therapeutic hypothermia.ResultsThe relationship between CVP and mean SctO2 was best described by an S-shaped, third-degree polynomial regression curve (SctO2 = −0.002 × CVP3 + 0.08 × CVP2 – 1.07 × CVP + 69.78 %, R2 0.89, n = 1,949,108 data points) with high CVP (>20 mmHg) being associated with cerebral desaturation. Multivariate linear regression revealed CVP to be a more important determinant of SctO2 than mean arterial pressure (MAP) without important interaction between both (SctO2 = 0.01 × MAP – 0.20 × CVP + 0.001 × MAP × CVP + 65.55 %). CVP and cardiac output were independent determinants of SctO2 with some interaction between both (SctO2 = 1.86 × CO – 0.09 × CVP – 0.05 × CO × CVP + 60.04 %). Logistic regression revealed that a higher percentage of time with CVP above 5 mmHg was associated with lower chance of survival with a good neurological outcome (cerebral performance category (CPC) 1–2) at 180 days (OR 0.96, 95 % CI 0.92–1.00, p = 0.04). In a multivariate model, the negative association between CVP and outcome persisted after correction for hemodynamic variables, including ejection fraction and MAP.ConclusionsElevated CVP results in lower brain saturation and is associated with worse outcome in post-CA patients. This pilot study provides support that venous cerebral congestion as indicated by high CVP may be detrimental for post-CA patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1297-2) contains supplementary material, which is available to authorized users.

A proposal to explain “covert” increases in intracranial pressure

Some substantial number of unfortunate patients suffer from the symptoms and signs of elevated cerebrospinal fluid (CSF) pressure, even though pressure measured in the cerebral venous system is normal. We hypothesize that, with elevated CSF pressure, cerebral microvascular congestion may occur, even though (subdural) large-vein pressure has been shown to be normal.

Abnormal U-shape course of central venous catheter.

Sir, A 50-year-old male patient with shortness of breath was referred from other hospital to our center. After doing all routine blood investigations and bedside chest X-ray in the casualty ward, patient was transferred to intensive care unit. Patient had triple lumen central venous catheter (CVC) in right internal jugular vein (IJV) which was inserted in outside hospital. However, there was no back flow in all 3 lumens, so it was removed. Chest X-ray revealed abnormal U-shape course of CVC [Figure 1]. Before inserting new central venous line, ultrasound of right IJV was done which showed large valve in right IJV [Figure 2]. Central line was inserted in left IJV under ultrasound guidance. Back flow in all 3 lumens of CVC was present. Figure 1 Chest X-ray showing abnormal U-shape course of central venous catheter Figure 2 Ultrasound image showing large valve in internal jugular vein Valve in IJV is present in 88-100% of cases. It inhibits retrograde flow from the right atrium to the brain.[1] This valve prevents a sudden increase in the jugular venous pressure during positive pressure ventilation or conditions with raised abdominal pressure (e.g., ascites). Thereby it prevents cerebral congestion by avoiding excessive backward flow to the brain.[1] The types of valve leaflet can be unicuspid (1.4-16%), bicuspid (77-98%) or tricuspid (0-7%).[2] There is a risk of persistent incompetence of the IJV valve by CVC.[3] Valve damaged during IJV catheterization can be a site for thrombus formation[1] Large venous valve causing difficult central catheter placement has been reported.[4] In the present case, large valve in IJV might have changed the course of guidewire in the reverse direction. CVC rolled over the guidewire acquired the same U-shape course of guidewire. There was no backflow in all 3 lumens due to reverse bent of CVC at IJV valve. It is always better to do ultrasound screening of course and structure of IJV before CVC.

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

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.