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Abstract Details

Jugular Variant Bow-Hunter’s Syndrome from Sternocleidomastoid Entrapment of the Internal Jugular Vein
Neuro-ophthalmology/Neuro-otology
P11 - Poster Session 11 (5:30 PM-6:30 PM)
10-001
Current pathophysiological models of head rotation-triggered vertigo do not adequately explain the prevalence or diversity of clinical features associated with head rotation-induced vestibular symptoms that occur in the upright position.
To present the imaging and clinical features of jugular variant Bow-Hunter’s syndrome (BHS) in order to distinguish it from arterial BHS in patients with head rotation-induced vertigo.
Case series of patients presenting with head rotation-induced vertigo imaged with quantitative venous ultrasound of the neck and thoracic outlet, CT venogram of the head and neck, and digital subtraction venography of the internal jugular vein (IJV).

Twelve patients were treated over a 3-year period for jugular BHS (10 women, 2 men, age at presentation 46.3+/- 13.2 years, median= 44 (31-74) years, duration of symptoms before presentation= 4.6+/-5.6 years, median 1.75 (0.083-15) years). Five had concurrent jugular vein compression at C1 (Eagle’s syndrome), 10 had concurrent thoracic outlet syndrome, and 5 had concurrent pectoralis minor syndrome. Venography showed compression of the IJV under the SCM induced by head turning with massive retrograde flow to the skull base including the petrosal sinuses that drain the inner ear. Venous shunting occurred down the vertebral veins that drain the cervical spinal cord. Seven patients underwent bilateral SCM partial myotomies; one unilateral decompression. Four patients were treated with bilateral SCM and anterior scalene Botox without surgery. 11 patients experienced resolution or >70% improvement in head motion-triggered vertigo. One patient reobstructed and had no improvement. Other improved symptoms included syncope, headache, pulsatile tinnitus, neck pain, and limb paresthesias.

SCM entrapment of the IJV causing a "jugular BHS," represents a significant and more common mechanism for head rotation-induced vertigo compared to arterial BHS while also accounting for a wider variety of symptoms such as headache, tinnitus, paresthesias, and myofascial pain. Symptoms can be managed with PT, Botox, or surgery. 

Authors/Disclosures
Yoon-Hee Cha, MD, FAAN (University of Minnesota)
PRESENTER
The institution of Dr. Cha has received research support from Mal de Debarquement Balance Disorders Foundation. Dr. Cha has received research support from University of Minnesota. Dr. Cha has received research support from MNDrive.
Kayla Chan No disclosure on file
Mahmood Gharib No disclosure on file
Joseph Karam No disclosure on file