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Liu P, Monnier H, Owashi K, Constans JM, Capel C, Balédent O. The Effects of Free Breathing on Cerebral Venous Flow: A Real-Time Phase Contrast MRI Study in Healthy Adults. J Neurosci 2024; 44:e0965232023. [PMID: 37968115 PMCID: PMC10860636 DOI: 10.1523/jneurosci.0965-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/10/2023] [Accepted: 08/31/2023] [Indexed: 11/17/2023] Open
Abstract
Quantifying the effects of free breathing on cerebral venous flow is crucial for understanding cerebral circulation mechanisms and clinical applications. Unlike conventional cine phase-contrast MRI sequences (CINE-PC), real-time phase-contrast MRI sequences (RT-PC) can provide a continuous beat-to-beat flow signal that makes it possible to quantify the effect of breathing on cerebral venous flow. In this study, we examined 28 healthy human participants, comprising of 14 males and 14 females. Blood flows in the right/left internal jugular veins in the extracranial plane and the superior sagittal sinus (SSS) and straight sinus in the intercranial plane were quantified using CINE-PC and RT-PC. The first objective of this study was to determine the accuracy of RT-PC in quantifying cerebral venous flow, relative to CINE-PC. The second, and main objective, was to quantify the effect of free breathing on cerebral venous flow, using a time-domain multiparameter analysis method. Our results showed that RT-PC can accurately quantify cerebral venous flow with a 2 × 2 mm2 spatial resolution and 75 ms/image time resolution. The mean flow rate, amplitude, stroke volume, and cardiac period of cerebral veins were significantly higher from the mid-end phase of expiration to the mid-end phase of inspiration. Breathing affected the mean flow rates in the jugular veins more than those in the SSS and straight sinus. Furthermore, the effects of free breathing on the flow rate of the left and right jugular veins were not synchronous. These new findings provide a useful reference for better understanding the mechanisms of cerebral circulation.
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Affiliation(s)
- Pan Liu
- CHIMERE UR 7516, Jules Verne University of Picardy, Amiens 80000, France
- Medical Image Processing Department, Amiens Picardy University Medical Center, Amiens 80000, France
| | - Heimiri Monnier
- CHIMERE UR 7516, Jules Verne University of Picardy, Amiens 80000, France
| | - Kimi Owashi
- CHIMERE UR 7516, Jules Verne University of Picardy, Amiens 80000, France
| | - Jean-Marc Constans
- CHIMERE UR 7516, Jules Verne University of Picardy, Amiens 80000, France
- Radiology Department, Amiens Picardy University Medical Center, Amiens 80000, France
| | - Cyrille Capel
- CHIMERE UR 7516, Jules Verne University of Picardy, Amiens 80000, France
- Neurosurgery Department, Amiens Picardy University Medical Center, Amiens 80000, France
| | - Olivier Balédent
- CHIMERE UR 7516, Jules Verne University of Picardy, Amiens 80000, France
- Medical Image Processing Department, Amiens Picardy University Medical Center, Amiens 80000, France
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2
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Laganà MM, Di Tella S, Ferrari F, Pelizzari L, Cazzoli M, Alperin N, Jin N, Zacà D, Baselli G, Baglio F. Blood and cerebrospinal fluid flow oscillations measured with real-time phase-contrast MRI: breathing mode matters. Fluids Barriers CNS 2022; 19:100. [PMID: 36517859 PMCID: PMC9749305 DOI: 10.1186/s12987-022-00394-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cervical blood and cerebrospinal fluid (CSF) flow rates can be quantified with Phase-contrast (PC) MRI, which is routinely used for clinical studies. Previous MRI studies showed that venous and CSF flow alterations are linked to various pathological conditions. Since it is well known that, besides the heart beating, the thoracic pump influences the blood and CSF dynamics, we studied the effect of different respiration modes on blood and CSF flow rates using a real-time (RT)-PC prototype. METHODS Thirty healthy volunteers were examined with a 3 T scanner. A RT-PC sequence was acquired at the first cervical level to quantify the flow rates of internal carotid arteries, internal jugular veins (IJVs) and CSF. Each RT-PC acquisition was repeated three times, while the subjects were asked to breathe in three different ways for 60 s each: freely (F), with a constant rate (PN) and with deep and constant respiration rate (PD). The average flow rates were computed, they were removed from the respective signals and integrated in the inspiratory and expiratory phases (differential volumes). Finally, the power spectral density was computed for each detrended flow rate. High- and very-high frequency peaks were identified on the spectra while their frequencies were compared to the respiratory and cardiac frequencies estimated using a thoracic belt and a pulse oximeter. The area under the spectra was computed in four 0.5 Hz-wide ranges, centered on the high-frequency peak, on very-high frequency peak and its 2nd and 3rd harmonics, and then they were normalized by the flow rate variance. The effect of breathing patterns on average flow rates, on systolic and diastolic peaks, and on the normalized power was tested. Finally, the differential volumes of inspiration were compared to those of expiration. RESULTS The frequencies of the high- and very-high spectral peaks corresponded to the respiratory and cardiac frequencies. The average flow rate progressively decreased from F to PN to PD breathing, and the cardiac modulations were less predominant especially for the IJVs. The respiratory modulation increased with PD breathing. The average volumes displaced in the inspiratory phases were not significantly different from those of the expiratory one. CONCLUSIONS The spectral analyses demonstrated higher respiratory modulations in PD compared to free breathing, even prevailing the cardiac modulation in the IJVs, showing an increment of the thoracic pump affecting the flow rate shape.
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Affiliation(s)
- Maria Marcella Laganà
- grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Sonia Di Tella
- grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy ,grid.8142.f0000 0001 0941 3192Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Francesca Ferrari
- grid.4643.50000 0004 1937 0327Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Laura Pelizzari
- grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Marta Cazzoli
- grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Noam Alperin
- grid.26790.3a0000 0004 1936 8606University of Miami, Miami, USA
| | - Ning Jin
- MR R&D Collaborations, Siemens Medical Solutions USA, Inc, Cleveland, OH USA
| | | | - Giuseppe Baselli
- grid.4643.50000 0004 1937 0327Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Francesca Baglio
- grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
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Cardiac and Respiratory Influences on Intracranial and Neck Venous Flow, Estimated Using Real-Time Phase-Contrast MRI. BIOSENSORS 2022; 12:bios12080612. [PMID: 36005008 PMCID: PMC9405895 DOI: 10.3390/bios12080612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/27/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022]
Abstract
The study of brain venous drainage has gained attention due to its hypothesized link with various neurological conditions. Intracranial and neck venous flow rate may be estimated using cardiac-gated cine phase-contrast (PC)-MRI. Although previous studies showed that breathing influences the neck’s venous flow, this aspect could not be studied using the conventional segmented PC-MRI since it reconstructs a single cardiac cycle. The advent of real-time PC-MRI has overcome these limitations. Using this technique, we measured the internal jugular veins and superior sagittal sinus flow rates in a group of 16 healthy subjects (12 females, median age of 23 years). Comparing forced-breathing and free-breathing, the average flow rate decreased and the respiratory modulation increased. The flow rate decrement may be due to a vasoreactive response to deep breathing. The respiratory modulation increment is due to the thoracic pump’s greater effect during forced breathing compared to free breathing. These results showed that the breathing mode influences the average blood flow and its pulsations. Since effective drainage is fundamental for brain health, rehabilitative studies might use the current setup to investigate if respiratory exercises positively affect clinical variables and venous drainage.
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4
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Real-Time Phase-Contrast MRI to Monitor Cervical Blood and Cerebrospinal Fluid Flow Beat-by-Beat Variability. BIOSENSORS 2022; 12:bios12060417. [PMID: 35735564 PMCID: PMC9221193 DOI: 10.3390/bios12060417] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/16/2022]
Abstract
Beat-by-beat variability (BBV) rhythms are observed in both cardiovascular (CV) and intracranial (IC) compartments, yet interactions between the two are not fully understood. Real-Time Phase-Contrast (RT-PC) MRI sequence was acquired for 30 healthy volunteers at 1st cervical level on a 3T scanner. The arterial (AF), venous (VF), and cerebrospinal fluid (CSF) flow (CSFF) were computed as velocity integrals over the internal carotid artery, internal jugular vein, and CSF. AF, VF, and CSFF signals were segmented in inspiration and expiration beats, to assess the respiration influence. Systolic and diastolic BBV, and heart period series underwent autoregressive power spectral density analysis, to evaluate the low-frequency (LF, Mayer waves) and high frequency (HF, respiratory waves) components. The diastolic VF had the largest BBV. LF power was high in the diastolic AF series, poor in all CSFF series. The pulse wave analyses revealed higher mean amplitude during inspiration. Findings suggests a possible role of LF modulation of IC resistances and propagation of HF waves from VF to AF and CCSF. PC-RT-MRI could provide new insight into the interaction between CV and IC regulation and pave the way for a detailed analysis of the cerebrovascular effects of varied respiration patterns due to exercise and rehabilitation.
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5
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Baselli G, Laganà MM. The intracranial Windkessel implies arteriovenous pulsatile coupling increased by venous resistances. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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6
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Tarumi T, Yamabe T, Fukuie M, Zhu DC, Zhang R, Ogoh S, Sugawara J. Brain blood and cerebrospinal fluid flow dynamics during rhythmic handgrip exercise in young healthy men and women. J Physiol 2021; 599:1799-1813. [PMID: 33481257 DOI: 10.1113/jp281063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/12/2021] [Indexed: 01/06/2023] Open
Abstract
KEY POINTS The cerebral fluid response to exercise, including the arterial and venous cerebral blood flow (CBF) and cerebrospinal fluid (CSF), currently remains unknown. We used time-resolved phase-contrast magnetic resonance imaging to assess changes in CBF and CSF flow dynamics during moderate-intensity rhythmic handgrip (RHG) exercise in young healthy men and women. Our data demonstrated that RHG increases the cerebral arterial inflow and venous outflow while decreasing the pulsatile CSF flow during RHG. Furthermore, changes in blood stroke volume at the measured arteries, veins, and sinuses and CSF stroke volume at the cerebral aqueduct were positively correlated with each other during RHG. Male and female participants exhibited distinct blood pressure responses to RHG, but their cerebral fluid responses were similar. These results collectively suggest that RHG influences both CBF and CSF flow dynamics in a way that is consistent with the Monro-Kellie hypothesis to maintain intracranial volume-pressure homeostasis in young healthy adults. ABSTRACT Cerebral blood flow (CBF) increases during exercise, but its impact on cerebrospinal fluid (CSF) flow remains unknown. This study investigated CBF and CSF flow dynamics during moderate-intensity rhythmic handgrip (RHG) exercise in young healthy men and women. Twenty-six participants (12 women) underwent the RHG and resting control conditions in random order. Participants performed 3 sets of RHG, during which cine phase-contrast magnetic resonance imaging (PC-MRI) was performed to measure blood stroke volume (SV) and flow rate in the internal carotid (ICA) and vertebral (VA) arteries, the internal jugular vein (IJV), the superior sagittal (SSS) and straight sinuses (SRS), and CSF SV and flow rate in the cerebral aqueduct of Sylvius. Blood pressure, end-tidal CO2 (EtCO2 ), heart rate (HR), and respiratory rate were simultaneously measured during cine PC-MRI scans. Compared with control conditions, RHG showed significant elevations of HR, mean arterial pressure, and respiratory rate with a mild reduction of EtCO2 (all P < 0.05). RHG decreased blood SV in the measured arteries, veins, and sinuses and CSF SV in the aqueduct (all P < 0.05). Conversely, RHG increased blood flow in the ICA, VA, and IJV (all P < 0.05). At the aqueduct, RHG decreased the absolute CSF flow rate (P = 0.0307), which was calculated as a sum of the caudal and cranial CSF flow rates. Change in the ICA SV was positively correlated with changes in the IJV, SSS, SRS, and aqueductal SV during RHG (all P < 0.05). These findings demonstrate a close coupling between the CBF and CSF flow dynamics during RHG in young healthy adults.
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Affiliation(s)
- Takashi Tarumi
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA
| | - Takayuki Yamabe
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Marina Fukuie
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - David C Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, Michigan, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas, USA.,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-shi, Saitama, Japan
| | - Jun Sugawara
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
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Bordoni B, Marelli F, Morabito B, Castagna R. A New Concept of Biotensegrity Incorporating Liquid Tissues: Blood and Lymph. J Evid Based Integr Med 2018; 23:2515690X18792838. [PMID: 30124054 PMCID: PMC6102753 DOI: 10.1177/2515690x18792838] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The definition of fascia includes tissues of mesodermal derivation, considered as
specialized connective tissue: blood and lymph. As water shapes rocks, bodily fluids
modify shapes and functions of bodily structures. Bodily fluids are silent witnesses of
the mechanotransductive information, allowing adaptation and life, transporting
biochemical and hormonal signals. While the solid fascial tissue divides, supports, and
connects the different parts of the body system, the liquid fascial tissue feeds and
transports messages for the solid fascia. The focus of this article is to reconsider the
model of biotensegrity because it does not take into account the liquid fascia, and to try
to integrate the fascial continuum with the lymph and the blood in a new model. The name
given to this new model is RAIN—Rapid Adaptability of Internal Network.
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Affiliation(s)
- Bruno Bordoni
- 1 Institute of Hospitalization and Care with Scientific Address, Foundation Don Carlo Gnocchi IRCCS, Milan, Italy.,2 CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore (VA) Piazza XXV Aprile 4, Italy.,3 CRESO, School of Osteopathic Centre for Research and Studies, Via Fanella, Fano (Pesaro Urbino), Italy
| | - Fabiola Marelli
- 2 CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore (VA) Piazza XXV Aprile 4, Italy.,3 CRESO, School of Osteopathic Centre for Research and Studies, Via Fanella, Fano (Pesaro Urbino), Italy
| | - Bruno Morabito
- 2 CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore (VA) Piazza XXV Aprile 4, Italy.,3 CRESO, School of Osteopathic Centre for Research and Studies, Via Fanella, Fano (Pesaro Urbino), Italy
| | - Roberto Castagna
- 2 CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore (VA) Piazza XXV Aprile 4, Italy
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8
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Marr K, Jakimovski D, Mancini M, Carl E, Zivadinov R. Jugular Venous Flow Quantification Using Doppler Sonography. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1762-1769. [PMID: 29784437 PMCID: PMC6026550 DOI: 10.1016/j.ultrasmedbio.2018.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/30/2018] [Accepted: 04/15/2018] [Indexed: 06/08/2023]
Abstract
A consensus on venous flow quantification using echo spectral Doppler sonography is lacking. Doppler sonography data from 83 healthy individuals were examined using manually traced transverse cross-sectional area and diameter-derived cross-sectional area obtained in longitudinal view measurements of the internal jugular vein. Time-averaged velocity over a 4-s interval was obtained in the longitudinal plane using manual tracing of the waveform. Manual and computer-generated blood flow volume calculations were also obtained for the common carotid artery, for accuracy purposes. No differences were detected between semi-automated and manual blood flow volume calculations for the common carotid artery. The manual calculation method resulted in almost twofold larger venous internal jugular vein flow measurements compared with the semi-automated method. Doppler sonography equipment does not provide accurate automated calculation of venous size and blood flow. Until further technological development occurs, manual calculation of venous blood flow is warranted.
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Affiliation(s)
- Karen Marr
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Marcello Mancini
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Rome, Italy
| | - Ellen Carl
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, New York, USA.
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9
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Bordoni B, Lintonbon D, Morabito B. Meaning of the Solid and Liquid Fascia to Reconsider the Model of Biotensegrity. Cureus 2018; 10:e2922. [PMID: 30197845 PMCID: PMC6126780 DOI: 10.7759/cureus.2922] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The definition of fascia includes tissues of mesodermal derivation considered as specialized connective tissues: the blood and lymph. As water shapes rocks, bodily fluids modify the shape and functioning of bodily structures. Bodily fluids are silent witnesses to mechanotransductive information, allowing adaptation and life, transporting biochemical and hormonal signals. While the solid fascial tissue divides, supports, and connects the different parts of the body system, the liquid fascial tissue feeds and transports messages for the solid fascia. This article reconsiders the model of biotensegrity, by revising the definition of solid and liquid fascia, and tries to integrate the fascial continuum with the lymph and blood in a new model, because in the previous model, these two liquid elements were not taken into consideration. The name given to this new model is Rapid Adaptability of Internal Network (RAIN).
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Affiliation(s)
- Bruno Bordoni
- Cardiology, Foundation Don Carlo Gnocchi Irccs/department of Cardiology, Institute of Hospitalization and Care, Milano, ITA
| | - David Lintonbon
- Osteopathic Technique, London School of Osteopathy, London, GBR
| | - Bruno Morabito
- Osteopathy, School of Osteopathic Centre for Research and Studies, Rome, ITA
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10
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Zhou D, Ding JY, Ya JY, Pan LQ, Yan F, Yang Q, Ding YC, Ji XM, Meng R. Understanding jugular venous outflow disturbance. CNS Neurosci Ther 2018; 24:473-482. [PMID: 29687619 DOI: 10.1111/cns.12859] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/17/2018] [Accepted: 03/18/2018] [Indexed: 12/11/2022] Open
Abstract
Extracranial venous abnormalities, especially jugular venous outflow disturbance, were originally viewed as nonpathological phenomena due to a lack of realization and exploration of their feature and clinical significance. The etiology and pathogenesis are still unclear, whereas a couple of causal factors have been conjectured. The clinical presentation of this condition is highly variable, ranging from insidious to symptomatic, such as headaches, dizziness, pulsatile tinnitus, visual impairment, sleep disturbance, and neck discomfort or pain. Standard diagnostic criteria are not available, and current diagnosis largely depends on a combinatory use of imaging modalities. Although few researches have been conducted to gain evidence-based therapeutic approach, several recent advances indicate that intravenous angioplasty in combination with stenting implantation may be a safe and efficient way to restore normal blood circulation, alleviate the discomfort symptoms, and enhance patients' quality of life. In addition, surgical removal of structures that constrain the internal jugular vein may serve as an alternative or adjunctive management when endovascular intervention is not feasible. Notably, discussion on every aspect of this newly recognized disease entity is in the infant stage and efforts with more rigorous designed, randomized controlled studies in attempt to identify the pathophysiology, diagnostic criteria, and effective approaches to its treatment will provide a profound insight into this issue.
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Affiliation(s)
- Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia-Yue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing-Yuan Ya
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li-Qun Pan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Yan
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu-Chuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xun-Ming Ji
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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