Jeon Young Hun, Yi Kyung Sik, Choi Chi Hoon, Kim Yook, Park Yeong Tae
Taehan Yongsang Uihakhoe Chi. 2021 Nov;82(6):1619-1627. doi: 10.3348/jksr.2021.0059. Epub 2021 Nov 4.
Central venous stenosis is a relatively common complication in hemodialysis patients; however, jugular venous reflux (JVR) and increased intracranial pressure are rare, and associated progressive visual disturbance was reported in only a few cases. Here, we report a case of JVR with visual disturbance and increased intracranial pressure. Notably, the MRI was accompanied by a dilatation of the superior ophthalmic vein, which was mistaken for a cavernous sinus dural arteriovenous fistula (CSdAVF). The patient had JVR on time-of-flight MR angiography (TOF-MRA) and severe stenosis of the left brachiocephalic vein on conventional angiography. After balloon angioplasty for central venous stenosis, he was discharged after improvement of his visual disturbance. Although JVR due to central venous stenosis and CSdAVF might show similar symptoms, treatment plans are different. Therefore, it is important to distinguish radiologically based on a thorough review of MRI and TOF-MRA and confirm the central venous stenosis on cerebral angiography for the accurate diagnosis.
中心静脉狭窄是血液透析患者相对常见的并发症;然而,颈静脉反流(JVR)和颅内压升高较为罕见,仅有少数病例报告伴有进行性视力障碍。在此,我们报告一例伴有视力障碍和颅内压升高的JVR病例。值得注意的是,MRI显示眼上静脉扩张,被误诊为海绵窦硬脑膜动静脉瘘(CSdAVF)。该患者在时间飞跃磁共振血管造影(TOF-MRA)上有JVR,传统血管造影显示左头臂静脉严重狭窄。在对中心静脉狭窄进行球囊血管成形术后,患者视力障碍改善后出院。尽管中心静脉狭窄和CSdAVF引起的JVR可能表现出相似症状,但治疗方案不同。因此,基于对MRI和TOF-MRA的全面评估进行影像学鉴别,并通过脑血管造影确认中心静脉狭窄以进行准确诊断非常重要。