Abstract
Radionuclide cerebral angiograms demonstrated massive jugular venous reflux in two children with clinical and electroencephalographic evidence of cerebral death. With an antecubital injection, the tracer flowed up the jugular vein, through the transverse dural sinus, and down the contralateral jugular vein. No arterial flow was seen. We hypothesize that this unusual pattern reflects the absence of normal antegrade flow through the venous system. The appearance of jugular reflux is distinct from arterial flow and should not be confused with it. These cases illustrate communication between the systemic venous system and the dural sinuses. Although this pattern in not diagnostic of cerebral death, the appearance of radiotracer in the dural sinuses does not establish the presence of cerebral perfusion.
This is a preview of subscription content, log in via an institution to check access.
References
Mishkin F (1975) Determination of death by radionuclide angiography. Radiology 115: 135
Goodman J, Heck L (1977) Confirmation of brain death at bedside by isotope angiography. JAMA 238: 966
Nagel CE (1980) Use of immediate static scans in combination with radionuclide cerebral angiography as a confirmatory test in the diagnosis of brain death. Clin Nucl Med 5: 152
Schwartz JA, Baxter J, Brill D, Burns JR (1983) Radionuclide cerebral imaging confirming brain death. JAMA 249: 246
Schwartz JA, Baxter J, Brill DR (1984) Diagnosis of brain death in children by radionuclide cerebral imaging. Pediatrics 73: 14
Brill DR, Schwartz JA, Baxter JA (1985) Variant flow patterns in radionuclide cerebral imaging performed for brain death. Clin Nucl Med 10: 346
Holden RW, Staab EV, Patton DD (1973) Endocranial venous collateral flow in unilateral innominate vein occlusion. Radiology 107: 353
Friedman BH, Lovegrove FTA, Wagner HN (1974) An unusual variant in cerebral circulation studies. J Nucl Med 15: 363
Lamoureux J (1975) Cervical venous reflux: a normal variant on radionuclide cerebral blood flow in nuclear medicine. AJR 124: 276
Hayt DB, Perez LA (1976) Cervical venous reflux in dynamic brain scintigraphy. J Nucl Med 17: 9
Steinbach JJ, Mattar AG, Dorsey TM (1976) Alteration of the cerebral bloodflow study due to reflux in internal jugular veins. J Nucl Med 17: 61
Yeh EL, Pohlman GP, Ruetz PP, Meade CM (1976) Jugular venous reflux in cerebral radionuclide angiography. Radiology 118: 730
Ogawa TK, So SK, Gerberg E, Kanter SA (1977) Jugular, dural sinuses, jugular reflux in dynamic brain flow imaging as a sign of unilateral innominate vein obstruction, case report. J Nucl Med 18: 39
Bok B, Marsault C, Aubin ML, Bar D, Aboulker J (1978) Jugular venous reflux in cerebral radionuclide angiography: an explanation. Eur J Nucl Med 3: 63
Rao BK, Polcyn RE, Lieberman LM (1981) Influence of respiratory maneuvers on jugular venous reflux. Clin Nucl Med 6: 23
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Shore, R.M., Rao, B.K. & Berg, O.B. Massive jugular and dural sinus reflux associated with cerebral death. Pediatr Radiol 18, 164–166 (1988). https://doi.org/10.1007/BF02387564
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02387564