Involvement of jugular valve insufficiency in cerebral venous air embolism.
BACKGROUND
Cerebral venous air entrapment is a rare finding on cranial computed tomography (CT) scan. Peripheral air embolism is discussed as a potential cause. However, the mechanism of retrograde passage through internal jugular valves and veins is unclear.


METHODS
The case of a patient is reported, who had air entrapment in the left cavernous sinus. Prior to CT scanning, a peripheral intravenous line had been placed. Ultrasound revealed excessive insufficiency of the left internal jugular valve. To further study the mechanism of embolism, an echo contrast agent was injected into the cubital vein. A Valsalva maneuver resulted in retrograde transition of microbubbles across the insufficient valve. Valvular function on the unaffected right side was intact.


CONCLUSIONS
This case report gives insight into the mechanism of cerebral venous air embolism. This is the firstcase describing jugular valve insufficiency as the missing link between peripheral air embolism and cerebral venous air entrapment.
Nedelmann
Max
M
Department of Neurology, Johannes Gutenberg University, Mainz, Germany. mnedelma@uni-mainz.de
Pittermann
Patrick
P
Gast
Klaus Kurt
KK
Mueller-Forell
Wibke
W
Dieterich
Marianne
M
D000328:Adult; D003937:Diagnosis, Differential; D004618:Embolism, Air / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000503:physiopathology*; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D014689:Venous Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*