For those who have been following this page for a bit, you may remember my references to Dr. Chung in Taiwan who has been studying the
jugular veins in relationship to transient global amnesia (TGA) and

other neurological disorders. Dr. Chung found that in those with

internal jugular vein valve problems, there was reflux of blood in their

jugulars when they used a valsalva maneuver...that means pushing air up

against a closed airway, or straining. This sent blood back up into

the brain, and created temporary ischemic (low oxygen) events, and Dr.

Chung postulated this is what causes temporary amnesia. Some

activities that create valsalva manuever are coughing, straining,

opening up plugged up ears, lifting, and stressful responses.

Now Dr. Chung has two new papers out on aging and the jugular veins. I
thought these were important to discuss after the ECTRIMS conference--

in which a researcher from the American University in Beirut stated that

CCSVI could not be important in MS, because he only found it in older

or more progressed MS patients. He and his team found CCSVI in 92% of

what he called "late MS" patients....those who had MS 10 years or more.

To anyone who knows MS, 10 years is not "late MS." I know many people

who have had MS 30 years and more, but let's get on with what Dr. Chung

discovered. Dr. Chung is now measuring venous return in the jugular

veins of the "healthy" elderly.

http://www.ncbi.nlm.nih.gov/pubmed/20800950

Cerebral venous outflow insufficiency via the internal jugular vein (IJV) is
associated with several neurological disorders. However, a normal

reference set of IJV hemodynamic parameters derived from a large,

healthy population over a wide range of age has, until now, been

lacking. Color-coded duplex sonography was performed on the IJVs of 349

subjects (55.60 ± 17.49,16 to 89 y; 167 M/182 F). With increasing age,

increased lumen area and decreased time-averaged mean velocity of

bilateral IJV and a decreased proportion of total flow volume, drainage

in the left IJV were found. The frequency of left jugular venous reflux (JVR) also increased with aging.

We report IJV hemodynamic parameters across a large population, which

could be used as a normal reference for clinical and research purposes.

Furthermore, we found a decreased proportion of venous drainage,

increased JVR prevalence, dilated lumen and slowed flow velocity in the

left IJV, all of which suggest increased left IJV outflow impedance with

aging. (E-mail: hhhu@vghtpe.gov.tw)

Now, this is very, very different than CCSVI...is this situation, the jugular veins is
dilated, which is stretched out or enlarged. Not like CCSVI where the

jugulars are pinched or tiny. But what interests me is that in the

elderly, there is less flow in the left jugular, more reflux and slowed

venous drainage. This appears to occur naturally with aging. Do you

see where I'm going with this? Add aging to someone with malformed

jugular veins and CCSVI, and you have a recipe for further disability in

those who are older and have had MS for more years.

Dr. Chung takes his research into slowed jugular vein flow in the elderly
one step further, and postulates that perhaps THIS is why we see white

matter lesions in the brains of the elderly. I, sadly, know all about

this. Since my Dad had these white matter lesions before he died

earlier this year. My Dad had been slowing down, acting more confused

and having cognitive problems. His neurologist explained that he had

"leukoaraiosis" or LA. This simply means my Dad had white matter

lesions (just like MS) but the doctors didn't know why. LA is the term

they use for these white spots when they don't have an explanation, like

MS.

So, Dr. Chung writes the following about LA-----

Leukoaraiosis (LA) is a major cause of vascular dementia and disability in the
elderly. Age and hypertension are the most two important risk factors.

Despite its clinical significance, the etiology is so far unclear.

Chronic cerebral hypoperfusion associated with vasogenic edema,

microbleeding or/and endothelial dysfunction found in LA favors venous

ischemia, in stead of arterial ischemia, as its pathogenesis. The

involved regions in LA, periventricular and subcortical regions, are the

drainage territory of deep cerebral venous system and the watershed

region between the superficial and deep cerebral venous system

respectively. Adding the facts that periventricular venule collagenosis,

and retinal and intraparenchymal venules dilatation are related to the

severity of LA, cerebral venous hypertension caused by downstream venous

outflow impairment might play a major role in the pathogenesis of LA.

Internal jugular vein is the main venous outflow pathway for cerebral

venous drainage. The frequency of jugular venous reflux (JVR) is

increased with aging. Hypertension, which has a decreased venous

distensibility, might further exacerbate the sustained or long-term

repetitive retrograde-transmitted cerebral venous pressure and venous

outflow insufficiency caused by JVR. Clinically, JVR caused by a dural

AV fistula does lead to cerebral hypoperfusion, white matter

abnormalities, vasogenic edema and cognitive impairment in several

published reports. JVR is suggested to play a key role in the

pathogenesis of LA through a sustained or long-term repetitive

retrograde-transmitted cerebral venous pressure and venous outflow

insufficiency, which might lead to chronic cerebral venous

hypertensions, abnormal cerebral venules structural changes, decreased

cerebral blood flow, endothelial dysfunction, and vasogenic edema in

cerebral white matters.

http://www.biomedsearch.com/nih/Pathogenesis-leukoaraiosis-Role-jugular-venous/20172657.html

Do you see that? Decreased cerebral blood flow, due to
hypoperfusion....JUST like what we have been discussing in CCSVI.

Retrograde cerebral pressure, in other words, reverse blood flow back

into the brain. All creating a low oxygen environment and leading to

white matter lesions in the elderly. Makes sense, doesn't it?

I hope Dr. Chung joins up with the International Society of Neurovascular
Diseases. They can use his specialized research into the jugular

veins...and I've suggested that they invite him to join in the

conversation. There is so much to be learned!!

Joan

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