title: Reflux of jugular and retrobulbar venous flow in transient monocular blindness.
abstract: OBJECTIVE
  Transient monocular blindness (TMB) attacks may occur during straining activities that impede cerebral venous return. Disturbance of cerebral and orbital venous circulation may be involved in TMB.
  
  
  METHODS
  Duplex ultrasonography and Doppler-flow measurement of jugular and retrobulbar veins were performed in 134 consecutive patients with TMB and 134 age- and sex-matched control subjects. All recruited patients received thorough examinations to screen for possible underlying causes.
  
  
  RESULTS
  Of the 134 patients with TMB, 48 patients had ipsilateral carotid arterial lesion and 7 patients had TMB attack(s) caused by cardiac embolism. Of the remaining 79 patients with undetermined cause, 46 had 3 or more TMB attacks (undetermined-frequent group) and 33 had fewer than 3 attacks. In comparison with the control subjects, the TMB patients had greater frequencies of jugular venous reflux (57 vs 30%; p < 0.0001; odds ratio [OR]: 3.079, 95% confidence intervals [CI]: 1.861-5.096) and flow reversal in the superior ophthalmic vein (RSOV; 37 vs 9%; p < 0.0001; OR: 6.052, CI: 3.040-12.048). The undetermined-frequent group had the greatest frequencies of jugular venous reflux (74%, 34 patients; OR: 6.66, CI: 3.13-14.17) and RSOV (59%, 27 patients; OR: 6.51, CI: 3.12-13.58). Of the 50 patients with RSOV, 47 (94%) had RSOV on the side of the TMB attacks.
  
  
  CONCLUSIONS
  The increased incidences of jugular and orbital venous reflux in TMB patients suggest that disturbance of cerebral and orbital venous circulation is involved in the pathogenesis of TMB, especially among patients with frequent attacks of undetermined cause.
authors.affiliation: Section of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Hsu
authors.forename: A-Ching
authors.initials: AC
authors.lastname: Chao
authors.forename: Yen-Yu
authors.initials: YY
authors.lastname: Chen
authors.forename: Fu-Yi
authors.initials: FY
authors.lastname: Yang
authors.forename: Chih-Ping
authors.initials: CP
authors.lastname: Chung
authors.forename: Wen-Yung
authors.initials: WY
authors.lastname: Sheng
authors.forename: May-Yung
authors.initials: MY
authors.lastname: Yen
authors.forename: Han-Hwa
authors.initials: HH
authors.lastname: Hu
mesh_terms: D000368:Aged; D020757:Amaurosis Fugax / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D001783:Blood Flow Velocity; D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000098:blood supply / Q000503:physiopathology; D011237:Predictive Value of Tests; D012160:Retina / Q000503:physiopathology; D012169:Retinal Vein / Q000503:physiopathology; D012170:Retinal Vein Occlusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D018616:Ultrasonography, Doppler, Duplex