case_images: PMC9238213_01
case_images: Central venous hypertension due to central venous stenosis in a 63-year-old hemodialysis patient, complaining with diplopia, diziness and headache.. A. Digital subtraction angiography shows tight stenosis between the graft-left internal jugular vein site (arrow), which interferes with antegrade flow and causes retrograde flow into the left internal jugular vein and the intracranial vein. The retrograde venous flow passes through the left sigmoid sinus, transverse sinus, and inferior petrosal sinus and back to the right internal jugular vein.. B. Initial time-of-flight-MRA shows in-flow signals at the intracranial sinuses, including the left sigmoid sinus and the left cavernous sinus (black arrow), correlating with the angiography findings. The left SOV also demonstrates an increased signal (white arrow). T2-weighted imaging also shows dilatation of the left SOV (white arrow).. C. Post-stent digital subtraction angiography shows an improvement in tight stenosis at the graft-left internal jugular vein site with mild residual retrograde flow into the left internal jugular vein.. D. Three months after the procedure, MRA demonstrates no in-flow signals in the venous sinuses nor in the left SOV (arrow).. MRA = MR angiography, SOV = superior ophthalmic vein
case_images: jksr-83-206-g001.jpg
case_images: PMC9238213_01_jksr-83-206-g001.jpg
case_images: F1
case_images: Also there was a backward blood flow from the left internal jugular vein and the flow drained into the right internal jugular vein through the right dural venous sinuses (Fig. 1A). Brain MRI and MR angiography (MRA) showed a time-of-flight (TOF) signal in the intracranial sinuses including the left sigmoid sinus and left cavernous sinus and also the left superior ophthalmic vein (Fig. 1B) without cavernous sinus bulging. A dilated left superior ophthalmic vein was also seen with flow void on T2-weighted imaging (Fig. 1B). The post-stent digital subtraction angiography showed no residual stenosis with mild residual retrograde blood flow along the left internal jugular vein (Fig. 1C). TOF signal in the intracranial sinuses and left superior ophthalmic vein had disappeared (Fig. 1D). The patient has been undergoing regular follow-ups at an outpatient clinic without neurologic symptoms.