Journal Mobile Options
Table of Contents
Vol. 29, No. 2, 2010
Issue release date: January 2010
Section title: Original Paper
Cerebrovasc Dis 2010;29:122–129
(DOI:10.1159/000262307)

Jugular Venous Reflux Affects Ocular Venous System in Transient Monocular Blindness

Chung C.-P. · Hsu H.-Y. · Chao A-C. · Cheng C.-Y. · Lin S.-J. · Hu H.-H.
Departments of aNeurology and bOphthalmology, Taipei Veterans General Hospital,and cInstitute of Clinical Medicine, National Yang-Ming University, Taipei, dSection of Neurology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, and eDepartment of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan

Do you have an account?

Register and profit from personalized services (MyKarger) Login Information

Please create your User ID & Password





Contact Information









I have read the Karger Terms and Conditions and agree.

Register and profit from personalized services (MyKarger) Login Information

Please create your User ID & Password





Contact Information









I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger (new!)
  • Unrestricted printing, no saving restrictions for personal use
  • Reduced rates with a PPV account
read more

Direct: USD 38.00
Account: USD 26.50

Select

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restriction apply

Rental: USD 8.50
Cloud: USD 20.00

Select

Subscribe

  • Automatic perpetual access to all articles of the subscribed year(s)
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 4/6/2009
Accepted: 8/8/2009
Published online: 12/1/2009

Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Background: The frequency of jugular venous reflux (JVR) is higher in patients with transient monocular blindness (TMB). We hypothesize that JVR influences ocular venous outflow, and resulting disturbances in cerebral and ocular venous circulation might be a cause of TMB. To substantiate this hypothesis, we aimed to demonstrate that: (1) TMB patients have vasculature changes in their retinal venules, and (2) JVR could influence ocular venous outflow, as revealed by dilated retinal venules. Methods: This study has 2 parts. The case-control study included 31 TMB patients and 31 age/gender-matched normal individuals, who all received fundus photography for retinal venule diameter comparisons. The Valsalva maneuver (VM) experiment included 30 healthy volunteers who received both color Doppler imaging of the internal jugular vein and fundus photography for retinal venule diameter measurement. Results: In the case-control study, TMB patients had a wider retinal venule diameter (184.5 ± 17.5 vs. 174.3 ± 16.2 µm, right eye, p = 0.023; 194.20 ± 24.6 vs. 176.6 ± 19.5 µm, left eye, p = 0.017), especially TMB patients with JVR. The VM experiments showed that the presence of JVR was associated with a greater increase in retinal venule diameters during VM in the subjects’ right eye (14.27 ± 11.16 vs. 2.75 ± 3.51%, JVR vs. non-JVR, p = 0.0002) and left eye (10.06 ± 6.42 vs. 1.80 ± 2.03%, p = 0.0003). Conclusions: These findings provide evidence that frequently occurring JVR associated with TMB impedes ocular venous outflow, and the subsequent disturbances in ocular venous circulation may be a cause of TMB.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 4/6/2009
Accepted: 8/8/2009
Published online: 12/1/2009

Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Gautier JC: Amaurosis fugax. N Engl J Med 1993;329:426–428.
  2. Andersen CU, Marquardsen J, Mikkelsen B, Nehen JH, Pedersen KK, Vesterlund T: Amaurosis fugax in a Danish community: a prospective study. Stroke 1988;19:196–199.
  3. Smit RL, Baarsma GS, Koudstaal PJ: The source of embolism in amaurosis fugax and retinal artery occlusion. Int Ophthalmol 1994;18:83–86.
  4. Sorensen PN: Amaurosis fugax: an unselected material. Acta Ophthalmol (Copenh) 1983;61:583–588.
  5. Kawaguchi S, Sakaki T, Iwahashi H, Fujimoto K, Iida J, Mishima H, Nishikawa N: Effect of carotid artery stenting on ocular circulation and chronic ocular ischemic syndrome. Cerebrovasc Dis 2006;22:402–408.
  6. Gállego J, Muñoz R, Martínez-Vila E: Emergent cerebrovascular disease risk factor weighting: is transient ischemic attack an imminent threat? Cerebrovasc Dis 2009;27:88–96.
  7. Akkawi NM, Agosti C, Borroni B, Rozzini L, Magoni M, Vignolo LA, Padovani A: Jugular valve incompetence: a study using air contrast ultrasonography on a general population. J Ultrasound Med 2002;21:747–751.
  8. Harvey W: Cardiac Classics. St Louis, C.V. Mosby, 1941.
  9. Silva MA, Deen KI, Fernando DJ, Sheriffdeen AH: The internal jugular vein valve may have a significant role in the prevention of venous reflux: evidence from live and cadaveric human subjects. Clin Physiol Funct Imaging 2002;22:202–205.
  10. Brownlow RL Jr, McKinney WM: Ultrasonic evaluation of jugular venous valve competence. J Ultrasound Med 1985;4:169–172.
  11. Hsu HY, Chao AC, Chen YY, Yang FY, Chung CP, Sheng WY, Yen MY, Hu HH: Reflux of jugular and retrobulbar venous flow in transient monocular blindness. Ann Neurol 2008;63:247–253.
  12. Chao AC, Hsu HY, Chung CP, Chen YY, Yen MY, Wong WJ, Hu HH: Altered retrobulbar hemodynamics in patients who have transient monocular blindness without carotid stenosis. Stroke 2007;38:1377–1379.
  13. Schaller B, Graf R: Cerebral venous infarction: the pathophysiological concept. Cerebrovasc Dis 2004;18:179–188.
  14. Tsai FY, Wang AM, Matovich VB, Lavin M, Berberian B, Simonson TM, Yuh WT: MR staging of acute dural sinus thrombosis: correlation with venous pressure measurements and implications for treatment and prognosis. AJNR 1995;16:1021–1029.
  15. Robinson MK, Halpern JI: Retinal vein occlusion. Am Fam Physician 1992;45:2661–2666.
  16. Schirmer CM, Hedges TR 3rd: Mechanisms of visual loss in papilledema. Neurosurg Focus 2007;23:E5.
  17. Attubato MJ, Katz ES, Feit F, Bernstein N, Schwartzman D, Kronzon I: Venous changes occurring during the Valsalva maneuver: evaluation by intravascular ultrasound. Am J Cardiol 1994;74:408–410.
  18. Hubbard LD, Brothers RJ, King WN, Clegg LX, Klein R, Cooper LS, Sharrett AR, Davis MD, Cai J: Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the Atherosclerosis Risk in Communities Study. Ophthalmology 1999;106:2269–2280.
  19. Knudtson MD, Lee KE, Hubbard LD, Wong TY, Klein R, Klein BE: Revised formulas for summarizing retinal vessel diameters. Curr Eye Res 2003;27:143–149.
  20. Rudnicka AR, Burk RO, Edgar DF, Fitzke FW: Magnification characteristics of fundus imaging systems. Ophthalmology 1998;105:2186–2192.
  21. Heier H, Brinchmann-Hansen O: Reliable measurements from fundus photographs in the presence of focusing errors. Invest Ophthalmol Vis Sci 1989;30:674–677.
  22. Patton N, Maini R, MacGillivary T, Aslam TM, Deary IJ, Dhillon B: Effect of axial length on retinal vascular network geometry. Am J Ophthalmol 2005;140:648–653.
  23. Awad IA, Barrow DL: Dural arteriovenous malformation. Chicago, American Association of Neurological Surgeons, 1993.
  24. Wong TY, Islam FM, Klein R, Klein BE, Cotch MF, Castro C, Sharrett AR, Shahar E: Retinal vascular caliber, cardiovascular risk factors, and inflammation: the multi-ethnic study of atherosclerosis (MESA). Invest Ophthalmol Vis Sci 2006;47:2341–2350.
  25. Wong TY, Shankar A, Klein R, Klein BE: Retinal vessel diameters and the incidence of gross proteinuria and renal insufficiency in people with type 1 diabetes. Diabetes 2004;53:179–184.
  26. Ikram MK, de Jong FJ, Vingerling JR, Witteman JC, Hofman A, Breteler MM, de Jong PT: Are retinal arteriolar or venular diameters associated with markers for cardiovascular disorders? The Rotterdam Study. Invest Ophthalmol Vis Sci 2004;45:2129–2134.
  27. Ikram MK, de Jong FJ, Van Dijk EJ, Prins ND, Hofman A, Breteler MM, de Jong PT: Retinal vessel diameters and cerebral small vessel disease: the Rotterdam Scan Study. Brain 2006;129:182–188.
  28. Ikram MK, de Jong FJ, Bos MJ, Vingerling JR, Hofman A, Koudstaal PJ, de Jong PT, Breteler MM: Retinal vessel diameters and risk of stroke: the Rotterdam Study. Neurology 2006;66:1339–1343.
  29. Wang JJ, Taylor B, Wong TY, Chua B, Rochtchina E, Klein R, Mitchell P: Retinal vessel diameters and obesity: a population-based study in older persons. Obesity 2006;14:206–214.

    External Resources

  30. Wong TY, Duncan BB, Golden SH, Klein R, Couper DJ, Klein BE, Hubbard LD, Sharrett AR, Schmidt MI: Associations between the metabolic syndrome and retinal microvascular signs: the Atherosclerosis Risk in Communities Study. Invest Ophthalmol Vis Sci 2004;45:2949–2954.
  31. Winterkorn JM, Kupersmith MJ, Wirtschafter JD, Forman S: Brief report: treatment of vasospastic amaurosis fugax with calcium-channel blockers. N Engl J Med 1993;329:396–398.
  32. Eadie MJ, Sutherland JM, Tyrer JH: Recurrent monocular blindness of uncertain cause. Lancet 1968;1:319–321.
  33. Henriksen O, Amtorp O, Faris I, Agerskov K: Evidence for a local sympathetic venoarteriolar reflex in the dog hindleg. Circ Res 1983;52:534–542.