A 60-year-old man presented with a 10-month history of of stereotypical spells characterized by vertigo, tinnitus, blurred vision, left hemibody numbness, and occasional syncope, precipitated by turning his head leftwards. Cerebral angiography and CT angiography of the head and neck with provocative maneuvers did not demonstrate vertebral artery narrowing. However, there was narrowing of the left internal jugular vein due to extrinsic compression from the sternocleidomastoid with leftward head rotation in the setting of hypoplasia of the right internal jugular vein. The patient underwent a cervical venogram which confirmed the finding. Manometric evaluation demonstrated a gradient of 29 mm Hg across the stenosis with the head turned leftwards compared with 1 mm Hg in the neutral position. The patient was treated with myectomies of the left sternocleidomastoid, posterior belly of the digastric, stylohyoid and omohyoid and styloid process removal. Following surgery, the patient reported complete resolution of symptoms. Repeat venography demonstrated resolution of the stenosis and pressure gradient.
- Intracranial Pressure
- Blood Flow
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Republished with permission from BMJ Case Reports Published online 20 December 2016, doi:10.1136/bcr-2016-012827
Contributors WB drafted the manuscript and made critical revisions. TZ, CSG and AP made critical revisions, prepared figures and participated in data collection and literature review. JRJ, GDC, GL and PPM made critical revisions, participated in data collection and literature review. All authors approved the final content of the manuscript.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Ethics approval was obtained from the Mayo Clinic IRB.
Provenance and peer review Not commissioned; externally peer reviewed.