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Reflux of jugular and retrobulbar venous flow in transient monocular blindness

Authors

  • Hung-Yi Hsu PhD,

    1. Section of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
    2. National Yang-Ming University, Taipei, Taiwan
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  • A-Ching Chao MD,

    1. Department of Neurology, Kaohsiung Medical University and Hospital, Kaohsiung, Taiwan
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  • Yen-Yu Chen MD,

    1. National Yang-Ming University, Taipei, Taiwan
    2. Section of Neurovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Fu-Yi Yang MD,

    1. National Yang-Ming University, Taipei, Taiwan
    2. Section of Neurovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Chih-Ping Chung MD,

    1. National Yang-Ming University, Taipei, Taiwan
    2. Section of Neurovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Wen-Yung Sheng MPH,

    1. National Yang-Ming University, Taipei, Taiwan
    2. Section of Neurovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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  • May-Yung Yen MD,

    1. National Yang-Ming University, Taipei, Taiwan
    2. Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Han-Hwa Hu MD

    Corresponding author
    1. National Yang-Ming University, Taipei, Taiwan
    2. Section of Neurovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
    • Neurological Institute, Taipei Veteran General Hospital, 201 Sec. 2, Shihpai Road, Taipei, Taiwan 11217
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Abstract

Objective

Transient monocular blindness (TMB) attacks may occur during straining activities that impede cerebral venous return. Disturbance of cerebral and orbital venous circulation may be involved in TMB.

Methods

Duplex ultrasonography and Doppler-flow measurement of jugular and retrobulbar veins were performed in 134 consecutive patients with TMB and 134 age- and sex-matched control subjects. All recruited patients received thorough examinations to screen for possible underlying causes.

Results

Of the 134 patients with TMB, 48 patients had ipsilateral carotid arterial lesion and 7 patients had TMB attack(s) caused by cardiac embolism. Of the remaining 79 patients with undetermined cause, 46 had 3 or more TMB attacks (undetermined-frequent group) and 33 had fewer than 3 attacks. In comparison with the control subjects, the TMB patients had greater frequencies of jugular venous reflux (57 vs 30%; p < 0.0001; odds ratio [OR]: 3.079, 95% confidence intervals [CI]: 1.861–5.096) and flow reversal in the superior ophthalmic vein (RSOV; 37 vs 9%; p < 0.0001; OR: 6.052, CI: 3.040–12.048). The undetermined-frequent group had the greatest frequencies of jugular venous reflux (74%, 34 patients; OR: 6.66, CI: 3.13–14.17) and RSOV (59%, 27 patients; OR: 6.51, CI: 3.12–13.58). Of the 50 patients with RSOV, 47 (94%) had RSOV on the side of the TMB attacks.

Interpretation

The increased incidences of jugular and orbital venous reflux in TMB patients suggest that disturbance of cerebral and orbital venous circulation is involved in the pathogenesis of TMB, especially among patients with frequent attacks of undetermined cause. Ann Neurol 2008

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