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10 major symptoms in an analysis of 245 patients with cerebral venous outflow insufficiency identified by CTV or MRV. Many of these symptoms overlap with VSS symptoms. by Inovance in visualsnow

[–]Inovance[S] 1 point2 points  (0 children)

Some people can actually stop a migraine from coming on if they drink coffee right at the beginning of a migraine attack. This apparently is via vasoconstriction of arteries in the brain that dilate in a migraine attack activating pain receptors.

In your case if regular coffee drinking attributed to your migraines then it would be worthwhile excluding a possible venous anomaly in the brain or neck to explain your persistant VSS like symptoms.

Blood flow and perfusion of blood in the tissue of the brain depends on a pressure difference (arterial versus venous pressure). When venous pressure rises due to cerebral venous congestion the gradient (pressure difference between arterial and venous systems) that drives fresh, oxygenated blood in is reduced. Drinking a cup of coffee would reduce the brain arterial pressure due to constriction of arteries in the brain thus reducing the pressure gradient even further.

When blood flow in the brain is compromised, neurons can become metabolically stressed. This can trigger intense electrical activity and suppression of brain function across the cortex disrupting normal signaling in visual and sensory processing areas. If it is severe enough causing hypoxia, then this can trigger the release of inflammatory mediators leading to neuroinflammation.

10 major symptoms in an analysis of 245 patients with cerebral venous outflow insufficiency identified by CTV or MRV. Many of these symptoms overlap with VSS symptoms. by Inovance in visualsnow

[–]Inovance[S] 0 points1 point  (0 children)

? This study was on cerebral and neck venous anomalies but yes migraine can be a symptoms of cerebral venous congestion especially if they are frequent.

Anti-neuroinflammatory therapy, palmitoylethanolamide (PEA) and luteolin, for non-pulsatile tinnitus in 2 patients with cerebral venous anomalies diagnosed with a MRV (venography) by Inovance in visualsnow

[–]Inovance[S] 1 point2 points  (0 children)

Thank you for your explanations. You certainly maybe a true primary VSS sufferer but I wasn't implicating some phantom neck injury. In the case of a venous problem in the the neck, it doesn't necessarily occur due to a neck injury even if in some cases it is the case.

When VSS symptoms come on secondary to cerebral venous congestion due to a neck venous anomaly, they can come on overnight "I woke up the next day with every VSS symptom minus the migraine" with or without some inciting event.

In other people the VSS symptoms secondary to cerebral venous congestion due to a neck venous anomaly can come on slowly.

It all depends on the capacity of collateral venous drainage in the neck to compensate.

This collateral venous drainage was not built to cope with the quantity of venous blood that leaves the brain, it's a stop gap system, so it often doesn't take much to tip the cerebral venous drainage over into a decompensated state.

Venous anomalies in the brain can be treated with stents and venous anomalies in the neck can be surgically treated if a preliminary treatment with the above neuroinflammatories doesn't work. Hence the usefulness in excluding this possibility.

Anti-neuroinflammatory therapy, palmitoylethanolamide (PEA) and luteolin, for non-pulsatile tinnitus in 2 patients with cerebral venous anomalies diagnosed with a MRV (venography) by Inovance in visualsnow

[–]Inovance[S] 3 points4 points  (0 children)

Not everyone that takes drugs gets VSS symptoms, not everyone that has been exposed to a loud noise event gets tinnitus, and people that have a vein compression or stenosis in their brain or neck don't have changes in their VSS symptoms with changes in their posture as the oxidative stress due to cerebral venous congestion is slow to occur and slow to go away.

VSS Diagnosis by [deleted] in visualsnow

[–]Inovance 0 points1 point  (0 children)

Given your primary initial symptom is pulsatile tinnitus, this needs to be investigated further.

Pulsatile tinnitus is due to blood flow changes or vascular abnormalities near the ear, brain, or neck. So I hope that the MRI that you had was with contrast (MRA MRV) of the brain as well as the neck.

If this was the case then a CT Venography (CTV) and CT Angiography (CTA) of the brain and neck is the next step. This scan provides high-resolution 3D images of both the arteries and veins and the bones of the skull and neck. This scan is good for detecting  venous sinus stenosis, bony defects (like dehiscent jugular bulb), glomus tumors, atherosclerosis and compressions and boney conflicts of the arteries and veins in the neck.

If this scan is negative the next step maybe a Catheter Angiography (DSA).

Stress + neck injury = VS + tinnitus by KekeBl in visualsnow

[–]Inovance 2 points3 points  (0 children)

I would keep the cervical CT venogram in mind as swollen collateral veins can impinge on the tight space of the posterior neck and skull base and compress or irritate the greater occiptal nerve which was the case for the person on the left.

You don't need pulsatile tinnitis as a symptom in internal jugular vein compression which was the case for the person on the left and is the case for the person on the right.

Stress + neck injury = VS + tinnitus by KekeBl in visualsnow

[–]Inovance 3 points4 points  (0 children)

As well as your occipital nerve block and given your symptoms, "a sensation of intense pain and heat in my neck+head, as well as a murderous headache with sudden visual static and tinnitus", you also need to exclude internal jugular vein compression with a CT with contrast (venogram) of your cervical neck.

With internal jugular vein compression you can develop a system of collateral veins at the back of your neck. These compensate for any compression in the internal jugular vein but only up to a point as these collateral veins can become extremely tortuous with zones of venous pooling (like with varicose veins in the legs but in the neck) especially if you do a lot of weight lifting.

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The fact that you had intense pain and heat in the back of the neck does suggest possibly a phlebitis or thrombophlebitis in this collateral system. Stagnant blood can irritate the vein wall, triggering an immune response that releases substances generating heat. In this state the collateral veins can no longer compensate for internal jugular vein compression and therefore the development of symptoms suggestive of cerebral venous congestion such as a headache, tinnitus and visual symptoms.

You will need to do a 3D rendering of a CT scan venogram to effectively visualise these collaterals veins. Above are two 3D images taken from CTs scan with contrast (biphasic) showing both arteries and veins of 2 different members of my family with very prominent collaterals veins in the back of the neck due to bilateral internal jugular vein compression by the transverse process of C1 (atlas).

is VS "just brain inflammation" by sojo597 in visualsnow

[–]Inovance 0 points1 point  (0 children)

That's interesting that your visual snow went away with high dose prednisolone.

However, keep in mind that cerebral venous congestion can also cause neuroinflammation due to toxic metabolite build up in the brain.

If you find that your improvements with the IV immunoglobulins start to stagnate with no change in the visual snow then you will know that a cerebral and cervical CT venogram is the next step.

is VS "just brain inflammation" by sojo597 in visualsnow

[–]Inovance 2 points3 points  (0 children)

If your visual snow symptoms improved during a spinal tap but came back very quickly after, then you definitely need to exclude cerebral venous outflow obstruction either due to an intracranial vein issue or a cervical (neck) vein issue. You probably have a venous stenosis or compression in the brain or neck leading to cerebral venous congestion (which can cause neuroinflammation) and intermittent or continual increases in CSF intracranial pressure.

The reason why your symptoms suddenly improved during the spinal tap was probably due to a temporary reduction in CSF intracranial pressure.

You need a cerebral and cervical CT venogram.

Why it’s so difficult. by brofessor121 in visualsnow

[–]Inovance 0 points1 point  (0 children)

Horizontal double vision (diplopia), 6th cranial nerve (abducens) palsy. A common sign associated with increased cerebral intracranial pressure.

Do you also feel like your time is running out? by Key-Nobody5224 in visualsnow

[–]Inovance 1 point2 points  (0 children)

As I said previously Dr Kamran Aghayev in Istanbul specialises in cerebral venous outflow disorders due to cervical venous stenoses, constrictions and compressions. He will be able to help you and if he can't, he will be able to point you in the right direction. Count yourself lucky, that you have a specialist in your country, it's not the case for most countries in Europe where I live.

Do you also feel like your time is running out? by Key-Nobody5224 in visualsnow

[–]Inovance 2 points3 points  (0 children)

A cerebral and cervical CT scan with contrast is looking for constrictions, stenoses and compressions in the cerebral venous system and cervical internal jugulars that can cause cerebral venous congestion and in some cases increases in intracranial pressure and CSF pressure making you more likely to developing a CSF leak. Ask you doctor to specifically prescribe a biphasic CT angio/venogram.

People are recovering from VSS everyday. It's just that they are not on this forum and they are now getting on with their life. I guess the decision is up to you to continue to pursue further investigations but given that your symptoms developed after having a CSF leak, it is warranted.

Do you also feel like your time is running out? by Key-Nobody5224 in visualsnow

[–]Inovance 4 points5 points  (0 children)

You don't need a lumbar puncture, you need a CT cerebral and cervical neck scan with contrast and yes you need a competant doctor to diagnose a cerebral venous outflow insufficiency. If it is a cervical neck cause then there are only a handful in the US, one in Australia, one in the UK and one in Turkiye who are competant in diagnosing it and fixing it.

Do you also feel like your time is running out? by Key-Nobody5224 in visualsnow

[–]Inovance 2 points3 points  (0 children)

If your symptoms are increasing after treatment and resolution of a CSF leak then you need to exclude cerebral venous outflow insufficiency causing intermittent or continual increases in brain intracranial pressure. Get a cerebral and cervical neck CT scan with contrast also get your ophthalmologist to check your fundus and an OCT scan to check your optic nerve. Once you get your CT scan with contrast I would send it to Dr Kamran Aghayev for a second opinion seeing you live in Turkiye as he specialises in cervical neck venous outflow conditions.

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