Headache. Disturbances of venous outflow - what are doctors silent about?

05/10/2021 | Category Symptoms of cervical osteochondrosis

Many who had an ultrasound of the neck saw in the conclusion the phrase “impaired venous outflow.” Let us immediately note that if this is discovered, this is already good, it means that the doctor looked carefully, not in a hurry, and did not miss anything. Sometimes there is no such record, although in fact there is a problem. The lack of recording may be due to various reasons, including due to outdated equipment; we will not dwell on this, but further we will describe the factors and symptoms by which it can be understood that the venous outflow is impaired, even if this is not indicated by the ultrasound results.

What is a venous outflow disorder?

First of all, let's understand the anatomy. Imagine a spine. Veins run next to it, through which blood should flow freely from the head down. If the vertebrae are displaced, then the veins can be pinched, deformed, and because of this their capacity is reduced. Blood accumulates in the posterior cranial fossa.

With normal intracranial pressure, there is no outflow of blood through the compressed vessels. In order for the outflow to be restored, the blood must flow with greater pressure, that is, the pressure must increase. We all know that increasing blood pressure is not beneficial for the body, to put it mildly, and here it is a necessary measure to restore blood circulation, otherwise more serious problems will arise.

In the long term, stagnation of blood and impaired circulation in the brain are fraught with many bad consequences, but there is no need to be afraid. The human body is excellent at recovering on its own, plus it informs in advance about possible problems with unpleasant and even painful sensations. Therefore, you need to listen to your body and simply help it be healthy, which is not difficult to do.

After an increase in pressure, a sharp outflow occurs through the posterior or jugular veins. Changes in the condition of the jugular veins are easier to see on an ultrasound than changes in the vessels near the spine, on the back of the neck.

Helpful advice

When you go for an ultrasound, be sure to ask to look at the jugular veins. If they write to you that they are dilated, this is an accurate sign of venous stagnation and circulatory disorders in the brain.

Reference. It is more difficult to see a similar sign of a disorder in the spine. Therefore, it may be that the problem is already there, but it is not yet visible when examining the back of the neck.

The jugular veins dilate and lose elasticity when large volumes of blood are dumped through them. As a result, blood circulation worsens even more, and the body signals this with pain.

How to improve venous drainage of the brain

To improve venous outflow from the brain when it is dysfunctional, medications (Actovegin, Detralex), neck exercises, massage, diet with limited salt and sufficient intake of dietary fiber, medicinal plants, leeches, and physiotherapy are used. It is important to monitor working conditions.

Treatment with drugs

To treat circulatory disorders in the veins of the brain, drugs from the following groups are used:

Exercises

For dysfunctional venous congestion, a set of exercises for the neck is useful ; it can be done even at your desk:

• lowering your shoulders down, try to reach the top of your head towards the ceiling, relax and repeat 10 times;
• tilting the head to the shoulder, while trying not to bend the neck, but stretching it as far as possible to the side (10 times to the right and left);
• pushing the chin forward (snake head) and pulling the back of the head back with a delay of 10 counts in each final position;
• turning the head to the sides with the shoulders lowered as much as possible (10 repetitions each);
• pull your shoulders towards your ears, and then with a sharp movement throw them down 10 times.

Expert opinion Alena ArikoExpert in the field of cardiology With venous dysfunction of the brain, headstand exercises, heavy lifting, and hanging on rings are contraindicated. All movements should be smooth, without jerking.

• Hemorrhagic cerebral stroke: what it is, symptoms and consequences

Massage

Massage of the cervical-collar area is considered effective to improve venous outflow. It is better if it is carried out by a specialist, but to relieve headaches and heaviness in the head, several techniques can be done independently:

• use your fingers to move in the direction from the forehead to the neck with intense pressure on the skin 3 times, as if moving it back;
• perform stroking from the back of the head to the shoulders (from the center to the sides) 5 times;
• stretch and knead the back of the neck from top to bottom (3 times) and from the center to the sides (3 times);
• tap with the tips of 4 fingers from the crown to the back of the head and along the shoulders;
• repeat the first movement, but without effort.

Nutrition

It is necessary to exclude from the diet foods that retain fluid in the body:

• pickles,
• marinades,
• smoking,
• sausages,
• hot sauces,
• fried foods.

Table salt is limited to 5 g per day. This means that you need to cook without it, and add salt to the already prepared dish. It is useful to replace the table with pink Himalayan. To improve blood flow, the diet should include:

• proteins – low-fat dairy, meat and fish products;
• vegetables with coarse fiber - cabbage, pumpkin, beets, fresh salads;
• black bread, bran;
• fruits, berries;
• dried fruits – prunes, dried apricots;
• drinking water – no more than 1.5 liters, it should be drunk in small portions.

If you are prone to constipation, kefir or fresh yogurt is recommended before bed; it is better to prepare them at home using pharmacy starters.

To enhance the laxative effect, an hour before taking, you can add a mixture of a teaspoon of bran and 4 prunes (they are pre-steamed with boiling water for 30 minutes).

Traditional methods

To treat venous dysfunction in the brain, a collection of herbs is used:

• crushed chestnut fruits 50 g,
• raspberry leaf 20 g,
• peony flowers 20 g,
• horsetail herb 10 g.

A tablespoon of the mixture is poured into a glass of boiling water and cooked in a water bath for 30 minutes, and then left for 1.5 hours. After straining, take 50 ml half an hour before meals 4 times a day for 45 days. After a 15-day break, the course can be repeated.

Hirudotherapy

For cyanotic skin and severe venous stagnation, hirudotherapy is used - leeches are placed on the occipital and retroauricular area. Prescribe 5-7 sessions 2 times a week. The secretion of the salivary glands of leeches contains hirudin, which:

• reduces blood viscosity;
• improves nutrition of brain cells;
• reduces swelling;
• accelerates the movement of blood through veins and arteries;
• relieves pain.

Physiotherapy

To treat dysfunction of the venous outflow in the brain, the following is used:

• phonophoresis (ultrasonic injection) of Troxevasin ointment on the collar area;
• galvanic collar;
• laser and magnetic therapy;
• hydrogen sulfide, carbon dioxide baths.

The high effectiveness of sanatorium-resort treatment has been proven, since physical and climatic conditions are used simultaneously.

Symptoms of impaired venous outflow

Headache

The most common symptom is pain due to increased intracranial pressure. The blood does not leave the head on time, and new portions of it continue to flow - the pressure rises, the body signals this with a headache.

A case from the practice of Dr. Shishonin

The man was diagnosed with migraine and prescribed medication. The patient took the pills with discipline, but there was no noticeable improvement. Migraine attacks did not become less frequent and were often as severe as before starting to take the drugs. The attack was very difficult to relieve with analgesics; you had to take the maximum allowable doses, and even they did not always work. The pain went away on its own after some time.

Dr. Shishonin recommended going for an ultrasound under the compulsory medical insurance policy and asking to look at the jugular veins. An ultrasound showed that they were dilated. The cause of the migraine became clear - increased intracranial pressure.

After conservative non-drug treatment, improvement occurred within two months.

Extreme migraine

A very painful symptom occurs due to loss of elasticity of the jugular veins. Up to a certain point they can withstand the increased load, and then they can no longer cope. Swelling appears in the brain stem. They are not yet dangerous to human life and health, but they cause severe pain in the ternary nerve.

This is an extreme degree of migraine, it is almost impossible to tolerate and difficult to relieve with analgesics. A person becomes incapacitated, no matter how strong his will is. In addition, nausea occurs, the patient is physically unable to drink liquids or eat food. A migraine can last a day and goes away on its own when the pressure rises to such an extent that blood discharge does occur. If such conditions are repeated frequently, it becomes potentially dangerous.

Ptosis of the eyelid

A case from the practice of Dr. Shishonin

The person suddenly developed ptosis and the mobility of the eyelid was impaired. The hospital carried out a full examination - a microstroke was not confirmed, and no tumor was found.

An ultrasound scan examined the veins in the neck and revealed gross venous congestion. Conservative treatment without pills gave results after six months. If a person had paid attention to the headaches that he often had earlier, the problem could have been solved faster.

Labored breathing

This symptom itself is ambiguous; there can be many reasons. But if it is accompanied by regular pain in the back of the head or temples, then the cause is most likely venous stagnation.

Lack of air due to a violation of venous outflow can occur either unexpectedly and without cause (not during physical activity, not in a stuffy room), or, as they say, out of the blue - during a walk, in a well-ventilated room. If such situations recur, and under different conditions, you need to check and treat the neck first.

What else you need to know about symptoms

There are many signs of circulatory problems. Any discomfort in the head, neck, chest, or upper back may indicate this problem. You need to undergo an examination, and in any case it will be useful to do simple exercises. Unlike pills, carefully performed gymnastics and gentle self-massage have no side effects, that is, in any case the condition will not worsen.

The main principle of the doctor is Primum non nocere (“First of all, do no harm”). Therefore, Dr. Shishonin recommends making maximum use of the natural recovery abilities inherent in our body.

Diagnostics

Based on the examination results, the specialist prescribes treatment for blood vessels and veins. The doctor examines the patient, inquires about symptoms and complaints. If there is doubt about the diagnosis, the patient is referred to procedures such as:

• Obstruction of venous outflow of the brain in children

• Magnetic resonance imaging.
• Ultrasound examination of cerebral vessels.
• CT scan.
• Angiography of cerebral vessels.

These examinations help to establish the root cause of the disturbance in the venous outflow of blood in the brain area.

If, as a result of the examination, the patient is found to have abnormalities in the area of ​​the jugular vein, this can cause pronounced symptoms that provoke discomfort, the development of other diseases, and the occurrence of pathologies of the brain and venous outflow. During diagnosis, the eyeball must be examined, as blood stagnation may occur there.

In most cases, the disease (venous drainage of the brain) is accompanied by venous expansion in the legs, so complex treatment is carried out. The patient is prescribed medications and various exercises.

How can you help yourself without pills?

There are two simple ways. The first can be used by each person independently without preparation. The second one is a little more difficult, but regular viewers and readers of Dr. Shishonin will master it very quickly.

It is better to use both methods: working on the points on the sides of the front of the neck, and working under the back of the head. This way, you will not only get rid of headaches and other symptoms of impaired venous outflow, but you will also feel more energetic, your mood and memory will improve. The main thing is to regularly devote time to yourself and help your body recover. The capabilities of the human body are almost limitless, but you need to develop them by doing gymnastics and self-massage.

What is the threat of the disease?

Venous discirculation is conventionally divided into 3 stages:

1. Latent. Accompanied by minor symptoms such as moderate headache, poor sleep. Often the patient refers to fatigue and does not consult a specialist.
2. Cerebral dystonia. This stage is accompanied by an increase in the intensity of headaches, vomiting, insomnia, and fainting may occur.
3. Venous encephalopathy. The onset of this stage means that some processes may become irreversible: vision and hearing deteriorate, and epileptic seizures occur. Urgent medical attention is required.

Even at the initial stage, a violation of the venous outflow to the brain means that the brain cells are not sufficiently supplied with blood, so treatment should not be delayed. The longer the brain is “without nutrition”, the more difficult it will be to reverse the symptoms of the disease.

Options for the development of the disease can be:

• Hand tremors;
• epilepsy;
• VSD (vegetative-vascular dystonia);
• muscle tissue atrophy;
• hydrocephalus;
• increased intracranial pressure;
• cardiovascular diseases;
• coma;
• stroke.

IMPORTANT! If left untreated, venous discirculation can cause death, so if alarming symptoms occur, you should consult a specialist.

Self-massage in the collarbone area

Working out certain points improves blood flow through the jugular veins. This will help immediately reduce or completely eliminate headaches caused by blood stagnation. If you do this self-massage regularly, the veins will become more elastic, resilient and begin to work like pumps, draining blood from the head in time. Accordingly, headaches will stop without taking medications. This is important because any drugs have side effects, including those delayed over time. It is imperative to use the body’s natural ability to heal itself.

Self-massage technique step by step:

1. Place two fingers in the middle of the collarbone - just above the jugular fossa.
2. Lightly press on the point - the pressure should not be strong, but should feel pleasant.
3. Start working the point with circular rotations clockwise or counterclockwise - whichever is more comfortable for you.
4. Do 20-30 rotations.
5. Move to the other side of the neck and repeat steps 1-4.

Important! Please note again that you cannot put pressure on the point. Throughout the self-massage there should be pleasant sensations, and after its completion - a feeling of vigor or pleasant relaxation (depending on the time of day). This is a marker that you are doing everything right.

How often to perform

Everything is individual here. For some, it will help the first time and the headache will subside for a long time, for others, several sessions in a row are needed, and then maintain the condition of the veins with preventive self-massage.

If you have a diagnosed migraine, you need to start working on the point as soon as the first signs of pain appear. As soon as there is the slightest hint of imminent pain, we immediately do it. This will certainly reduce the intensity of pain and will most likely stop its further development. That is, a terrible migraine attack, for which even pills don’t help, simply won’t happen, your head will hurt a little, but it will go away after working on the clavicular point.

To prevent migraines, if they happen several times a month or a year, it is useful to do self-massage every week. This will help maintain the elasticity of the veins and blood vessels, so the blood will circulate correctly, without stagnation. The risk of not only headaches, but also increased intracranial pressure will be reduced.

Venous discirculation in childhood and adolescence

Introduction

Vascular lesions of the nervous system are an important problem in modern clinical neurology.
The study of cerebral venous circulation disorders remains one of the urgent tasks of modern medicine. The improvement of ultrasound equipment, as well as its software, has led to the fact that when studying blood flow in the arteries of the brain, it is possible to assess the state of venous blood flow at a fairly good level.

However, the main problem is that the data on the normative values ​​of velocities in the venous system of the brain are extremely scattered, fragmentary and not always unambiguous.
In this regard, you often have to rely on your own experience, taking as a basis data from a number of literary sources (Table 1), which are more consistent with the features of this device, the quality of the resulting image and the age of the patient. The small number of ultrasound studies, which would contain data on the state of venous blood flow at the extra- and even more so at the intracranial levels, is explained primarily by hardware features, and only then by the insufficient amount of information on this issue in the periodical literature, the complexity of the spatial-anatomical three-dimensional perception of the intracranial venous system by diagnosticians, low need for such studies on the part of neurologists. Table 1
. Blood flow indicators (Vmax, cm/s) in the internal jugular veins and in the main intracranial veins/sines of the brain.

Note. * - in children aged 1-12 months; ** - in children aged 1-3 years.

The purpose of this study was to assess correlation dependencies in patients with signs of venous discirculation at the intra- and extracranial levels, cerebral venous hemodynamics in children and adolescents with a clinical picture of “cranialgia”, with clarification of the cause-and-effect relationships that determine the formation of venous discirculation.

Material and methods

The study included 106 children aged from 2 to 18 years, average age 9.87 ± 3.9 years (from 2 to 6 years - 18 people, average age 3.8 ± 1.43 years; from 7 to 18 years - 88 people, average age 11.1 ± 2.99 years), sent for examination to the diagnostic center of Kaliningrad with a headache clinic or symptoms of vertebrobasilar insufficiency. During the examination, signs of dysgemia at the intra- and extracranial levels were identified in all of them. Doppler ultrasound studies of arterial and venous blood flow at the level of the neck and base of the brain were performed on a Medison Accuvix V10 device (South Korea), in B-, C-, PW-modes, linear (L5-12 MHz) and sector phased (P2- 4 MHz) sensors. Correlation dependencies were assessed between 94 clinical and instrumental indicators.

results

As a result of the study, it was found that discirculation in the vertebral vein (PV) system, as a rule, is a consequence of pronounced extravasal influences (vascular compression) on blood flow in the internal jugular vein (IJV) on the side of registration of dyshemia (r = + 0.67; p 0.05).

Dysgemia in the vein of Galen on the right is often accompanied by an increase in the tone of the VA, ICA and MCA on the ipsilateral side (as a consequence of reflex changes), just as the former is associated with kinks and S-shaped tortuosity of the ICA on the right. The effect of ICA tortuosity on venous outflow may be due to extravasal compression of venous vessels by tortuous arterial trunks with significantly higher intravascular pressure in the places of their closest abutment.

The relationship between “headache syndrome” and accelerated venous blood flow through the veins of Galen turned out to be extremely low (r = +0.22; p

In addition, a fairly clear picture of pronounced unilateral disturbances of both arterial blood flow and venous outflow was noted, which is probably due to the unity of the autonomic innervation of the arteriovenous system “head-neck”, the presence of complex compensatory mechanisms (reflex), as well as the indirect influence of the tone of the striated muscles neck and cervical spine, which is confirmed in a number of studies.

Discussion

From our own experience of working with devices from leading manufacturers of ultrasound equipment, it should be admitted that the best quality images of the cerebral venous network were often obtained using Medison Acuvix devices. At the same time, the images were of high quality in both C and PW modes, with a minimum of artifacts and interference.

Assessment of venous blood flow at the extracranial level (jugular veins, vertebral veins) causes fewer difficulties and is available on almost any device, except, perhaps, assessment of blood flow through the vertebral veins in persons with excess body weight, widespread osteochondrosis and a short neck, when even visualization vertebral arteries is carried out with great difficulty.

The structure of the cerebral venous system is presented in Figure 1.

Rice. 1.

Arteries and veins/venous plexuses at the base of the brain [11]. 1 - sphenoid-parietal venous sinus, 2 - middle cerebral artery (MCA), 3 - middle cerebral vein (deep), 4 - posterior cerebral artery (segment P1) (PCA), 5 - basilar venous plexus, 6 - basilar (main ) artery, 7 - vein of Rosenthal (right) and branch of the posterior cerebral artery (right), 8 - vertebral artery (segment V1), 9 - marginal venous sinus, 10 - vein of Galen (great cerebral vein), 11 - straight sinus, 12 - branch of the posterior cerebral artery (left), 13 - vein of Rosenthal (left), 14 - inferior ventricular vein.

Variants of normal and pathological venous blood flow are shown in Table 2 and Figures 2-18.

table 2

. Variants of normal and impaired venous blood flow in C- and PW-regimes. Causes of venous discirculation in the main venous pools. *

Note

*

The following should also be considered as possible causes of venous discirculation:

• violation of the central regulatory mechanisms of vascular tone;
• hereditary constitutional predisposition, manifested by undifferentiated connective tissue dysplasia (including in the form of bone deformities and hypermobility of the joints of the cervical spine);
• consequences of perinatal pathology (cervical spine injuries [12]; perinatal hypoxic-ischemic processes [13]);
• extravasal causes of venous stagnation: tumors of the mediastinum and neck; osteochondrosis of the cervical spine; traumatic compression of the chest and abdomen, leading to compression of the superior vena cava, jugular and vertebral veins; early osteochondrosis; deforming arthrosis; spondylosis; craniovertebral anomalies (basilar compression; defects of the odontoid process of the second cervical vertebra, Kimmerle anomalies; Arnold-Chiari anomalies);
• disorders of exclusively myogenic nature; compression of the vertebral artery by the inferior oblique muscle of the capitis during tonic tension with subsequent contracture or compression by the anterior scalene muscle;
• vasculitis of cerebral vessels, rheumovasculitis, bacterial meningitis, thrombosis of intracranial venous sinuses [10].

**

The literature covers various methods for invasive and non-invasive assessment of intracranial pressure (ICP) [7, 14]. In the specialized literature, the possibility of assessing ICP by displacement of the tympanic membrane is discussed [15]. However, this technique is described only for patients with hydrocephalus. The development of non-invasive methods for measuring ICP is still relevant, with various ultrasound and telemetric measurement methods taking the leading place. However, the question of the accuracy of the data obtained with non-invasive methods remains open and requires further clarification. None of the non-invasive techniques allows you to measure the absolute value of ICP, but only extrapolates its dynamics.

The only possible method for identifying ICH in patients with chronic venous insufficiency remains a comprehensive clinical and instrumental diagnosis, including assessment of the neurological status, condition of the fundus, Echo-encephalography (EchoEG), Dopplerography of the vessels of the neck (USDG BCS) and brain (TG USDG). Only the combination of these methods can bring the researcher closer to the expected conclusion. According to H. Bode [16], it is almost impossible to detect an increase in ICP in a child with hydrocephalus, based only on Doppler data.

In the studies of Yu.A. Rosin [17] proved the presence of a pressure gradient between the vein of Galen and the straight sinus. During transoccipital examination in the oral part of the straight sinus, in the area where the vein of Galen flows into the straight sinus, high venous outflow (more than 50 cm/s) is detected in children, which significantly exceeds the blood flow in the veins of Rosenthal, internal cerebral veins and the inferior sagittal sinus.

At the same time, a number of authors note that an increase in the tone of the main cerebral arteries should be considered as a compensatory mechanism for facilitating venous outflow [18].

The main hemodynamic signs of benign intracranial hypertension with transcranial Dopplerography (TCD) are considered to be an increase in maximum velocity and increased pseudopulsation of blood flow in the cerebral veins and sinuses (veins of Rosenthal > 15 cm/s, vein of Galen > 20 cm/s and straight sinus > 30 cm/s )

[1]. It is assumed that during chronically ongoing processes in the cranial cavity, venous circulation suffers more significantly.

It has been noted that a sharp increase in the venous signal and a change in the physiological direction of blood flow along the internal ophthalmic vein to retrograde are detected on the side of the “focus” of brain damage in cases of cerebrovascular accidents and traumatic brain injury, accompanied by an increase in intracranial pressure [13].

Rice. 2.

Middle cerebral artery (MCA). Transtemporal access. Color Doppler mapping mode at the level of the anterior cerebral artery (ACA) (3), MCA (5), first (7) and second (8) segments of the PCA, vein of Rosenthal (9), vein of Galen (10), middle cerebral vein (4), inferior ventricular vein (tributary vein of Rosenthal) (6). Brain peduncles (pedunculi cerebri) (1; 2).

Rice. 3.

Middle cerebral vein (deep). Right there. Color flow control, PW mode. Flow scanning in the vein of Rosenthal. Vmax 15.88 cm/s.

Rice. 4.

Posterior cerebral artery (segment P1) (PCA). Transtemporal access. Color flow control, PW mode. Scanning of pathological accelerated flow in the vein of Rosenthal. Vmax 28.59 cm/s.

Rice. 5.

Basilar venous plexus. Transtemporal access. Color flow control, PW mode. MCA (1), PCA segment P1 (4), cerebral peduncles (6; 7), middle cerebral vein (2), vein of Rosenthal (5). Flow scanning in the inferior ventricular vein (inflow of the vein of Rosenthal) (3).

Rice. 6.

Basilar (main) artery. Transtemporal access. Color flow mode at the level of the ACA (1), MCA (2), first segment of the PCA (4), middle cerebral vein (3). Brain peduncles (pedunculi cerebri) (5; 6).

Rice. 7.

Vein of Rosenthal (right) and branch of the posterior cerebral artery (right). Right there. Color flow control, PW mode. Flow scanning in the middle cerebral vein (proximal segment).

Rice. 8.

Vertebral artery (segment V1). Transtemporal access. Color flow control, PW mode. Scanning of pathological accelerated flow in the middle cerebral vein (proximal segment). Vmax 24.62 cm/s

Rice. 9.

Marginal venous sinus. Transtemporal access. Color circulation mode at the level of the first segment of the PCA (3), vein of Rosenthal (4), vein of Galen (5). Brain peduncles (pedunculi cerebri) (1; 2).

Rice. 10.

Vein of Galena (great vein of the brain). Right there. Color flow control, PW mode. Flow scanning in the vein of Gallen. Vmax 21.18 cm/s

Rice. eleven.

Direct sine. Transtemporal access. Color flow control, PW mode. Scanning of pathological accelerated flow in the vein of Galen. Vmax 50 cm/s

Rice. 12.

Branch of the posterior cerebral artery (left). Longitudinal scanning in the projection of the V2 segment of the vertebral artery (1) and vertebral vein (2). Color flow control and PW mode. Vmax in the vertebral vein is 34.69 cm/s.

Rice. 13.

Vienna of Rosenthal (left). Longitudinal scanning in the projection of the V1 segment of the vertebral artery (1). Color flow control and PW mode. Pathological accelerated flow in the vertebral vein (2). Vmax 83.73 cm/s.

Rice. 14.

Inferior ventricular vein. Transverse scanning in the projection of the internal carotid artery (3), external carotid artery (2) and internal jugular vein (1). Color flow control and PW mode. Vmax in the internal jugular vein is 41.49 cm/s.

Rice. 15.

Transverse scanning in the projection of the internal carotid artery (1) and the tortuous internal jugular vein (2). Color flow control and PW mode. Pathologically accelerated turbulent flow in the internal jugular vein up to 80 cm/s.

Rice. 16.

Transverse scanning in the projection of the internal (1) and external (2) carotid arteries, external jugular vein (3). Color flow control and PW mode. Vmax in the external jugular vein is 22.88 cm/s.

Rice. 17.

Transtemporal access. Mode of color circulation at the level of the MCA (2), and the sphenoparietal venous sinus (1). Brain peduncles (pedunculi cerebri) (3).

Rice. 18.

Ibid (Fig. 17). Color flow control, PW mode. Flow scanning in the sphenoparietal venous sinus (1). Vmax 19.19 cm/s.

Another problem facing the researcher, even in the case when it is possible to assess the nature of venous blood flow at the intra- and extracranial level, is the correct interpretation of the results obtained. Since the available literature data does not provide a holistic picture of the causes of venous discirculation, and in some cases, increased ICP or connective tissue dysplasia is indicated as the main reason for its occurrence, without indicating the possible mechanisms of the formation of venous discirculation, the benefit of such conclusions is extremely small. It is also impossible to influence the tactics of further treatment, since the points of possible application of efforts by doctors of different specialties are unknown or not indicated.

An increase in ICP as a probable cause of venous discirculation should not be forgotten that due to its low prevalence in the population (0.025-0.05% among children and adolescents), this pathology cannot be considered as the leading etiological cause of dysgemia and is most likely a diagnosis of exclusion.

Functional disorders of the musculoskeletal system with the formation of blocks in small joints of the spine with the appearance of reflex musculoskeletal pain syndromes are unreasonably rarely diagnosed, and the role of myofascial pain syndromes, in which the muscle suffers primarily, is underestimated. An important role in this in children is played by certain injuries to the cervical spine in the anamnesis (mainly during childbirth). The literature describes the mosaic nature of emerging pathogenetic factors in the obstruction of the outflow of venous blood from the skull. At the same time, the leading place in the genesis of dynamic disorders of venous circulation belongs to myofascial pain syndrome of cervical localization. When myofascial pain syndrome is localized in the muscles of the craniovertebral junction, congestive venous disorders are caused by general algic processes in this zone, including functional blockades of the junction, while tunnel-compression mechanisms in this zone do not play a decisive role in venous discirculation. Tunnel-compression mechanisms of obstruction of venous blood flow are most relevant in the middle and lower cervical localization of myofascial pain.

Conclusion

Taking into account our data on the strong correlation between accelerated venous blood flow and tortuosity of the ICA, VA (as indirect manifestations of disorders in the cervical spine, including manifestations of natal trauma to the cervical spine), we believe that in children and adolescents a key role in The appearance of dysgemia (impaired venous outflow) is played by the “pathology/structural features” of the cervical spine and the congenital structural features of the ICA at the extracranial level. The main causes of dysgemia in childhood should be considered “congenital connective tissue dysplasia” [19], manifested in the form of pathology of the cervical spine, with curvature and tortuosity of the bone canal, or “birth injuries with subluxation of 1-2 cervical vertebrae” (presence of a history of in the majority of examined individuals), with impaired venous outflow at the extracranial level.

Taking into account all of the above, it should also be concluded that if a picture of venous discirculation is identified, especially in young people, treatment should be aimed primarily at restoring the functional integrity of the musculoskeletal system of the cervical spine, correcting posture, manual practices, as well as compliance with regime-restrictive measures [20].

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Working out the back of the neck

As we have already found out, the problem arises due to compression of blood vessels, which is a consequence of the incorrect position of the vertebrae. Gymnastics will help solve and even more so prevent such a situation. For urgent help, you can gently influence the vessels. Let's take a closer look at how to do all this.

Gymnastics for the neck

Gymnastics should be performed regularly. Spend just 3-5 minutes a day and you will almost 100% protect yourself from headaches. A bonus is the prevention of high blood pressure – both intracranial and arterial.

There are many sets of exercises for the neck; you can see in detail, with step-by-step instructions and explanations, in Dr. Shishonin’s publications on cervical osteochondrosis. You've probably already read these articles and watched the videos, so let's briefly remind you. Tilts and rotations of the head, movements of the neck should not be performed abruptly, but carefully, so that there are pleasant sensations similar to those you experience when stretching after sleep.

Triggering a reflex response

The back of the neck can be treated with a piece of ice. The temperature effect causes a reflex reaction of the vessels: they react by restoring their shape. Dr. Shishonin spoke in detail about these techniques in specialized articles on cervical osteochondrosis.

Here we just remind you that you need to work with ice carefully. Don’t be afraid, you physically won’t be able to harm yourself, but don’t overdo it, otherwise the effect will be worse than from a delicate influence.

Disorders of the venous circulation of the brain

Classification. The following chronic and acute variants of venous circulation in the brain are distinguished. Chronic include venous congestion and venous encephalopathy, acute include venous hemorrhage, thrombosis of the veins and venous sinuses, thrombophlebitis.

Venous stagnation. The most common form of venous circulation disorder is due to various reasons: cardiac and cardiopulmonary failure, respiratory diseases (bronchitis, bronchiectasis, bronchial asthma, emphysema, etc.); compression of extracranial veins (internal jugular, innominate, superior vena cava), struma, arterial aneurysm, tumor in the neck; neoplasms of the brain, membranes and skull, arachnoiditis, traumatic brain injury, thrombosis of the veins and sinuses of the dura mater, compression of the veins with cerebral edema and craniostenosis. With venous stagnation, metabolic changes and brain hypoxia occur, venous and intracranial pressure increases, and cerebral edema develops. More often, milder disorders occur in the form of changes in the tone of the cerebral veins, which is detected using orbital plethysmography and rheography.

Clinical manifestations. A dull headache, more pronounced in the morning, increases with movements of the head to the sides, changes in atmospheric pressure, changes in ambient temperature, after excitement, drinking alcohol, etc., there is a hum or noise in the head, cyanotic lips, cheeks, ears, nose , mucous membranes of the oral cavity, swelling of the lower eyelids, especially in the morning, dilation of the veins in the fundus. Venous pressure ranges from 55 to 80 mmH2O, arterial pressure is usually within normal limits. Stupefaction, dizziness, darkening of the eyes, fainting, and numbness of the extremities are observed. Epileptic seizures and mental disorders are possible. With severe venous stagnation, patients are unable to lower their heads and remain in a horizontal position.

Measurements of pressure in the ulnar vein, radiography of the skull (increased development of diploic veins, graduates and veins of the dura mater), and phlebography are of diagnostic value in venous pathology.

Venous encephalopathy. With venous encephalopathy, the following syndromes are distinguished: hypertensive (pseudotumorous), diffuse small-focal brain damage, bettolepsy and asthenic.

Bettolepsy, or cough epilepsy, develops with chronic bronchitis and emphysema, pneumosclerosis, bronchial asthma, especially with cardiopulmonary failure. A persistent cough may result in sudden loss of consciousness (syncope).

Venous hemorrhages. Capillary-venous hemorrhages in the brain and capillary-venous stasis are observed in hypertension. Venous stroke occurs in patients with heart failure, traumatic brain injury, brain tumor, infectious and toxic brain lesions. Clinical manifestations develop slowly: confusion, speech disorders, diplopia, pyramidal reflexes, hemiparesis, hemihypesthesia, damage to cranial nerves.

Thrombosis of cerebral veins. It occurs in the practice of clinicians of many specialties as a complication of various inflammatory processes, infectious diseases, operations, abortions, pregnancy, childbirth, skull trauma, “blue” heart defects, etc. Changes in the walls of the veins, a slowdown in the speed of blood flow and increased blood clotting play a role in the pathogenesis, as well as a change in the colloidal properties of endothelial cells, which contributes to the aggregation of blood cells. Often, thrombosis of the cerebral veins is combined with thrombosis of the sinuses of the brain, as well as the veins of the lower extremities.

Clinical manifestations. Cerebral vein thrombosis usually develops gradually. Headache, nausea, vomiting, meningeal symptoms, congestive optic discs, increased body temperature, and increased ESR appear. In the cerebrospinal fluid, mild pleocytosis and an increase in protein content, sometimes blood, are detected. Characterized by confusion, partial motor-type seizures, and less commonly generalized convulsions. Depending on the location of the venous lesion, focal symptoms occur: aphasia, alexia, hemianopsia, flaccid or spastic paresis or paralysis, and sensory disturbances. The outcome is often favorable, focal symptoms often undergo significant or even complete regression, but there are relapses of the disease. A slow chronic course over many months and even years is possible. Sometimes there are consequences in the form of mental disorders, aphasia, convulsive seizures and paresis of the limbs.

Thrombosis of the dural sinuses. Usually develops when infection penetrates into them from a nearby focus (furuncles or carbuncles of the scalp, face, erysipelas, etc., purulent osteomyelitis of the skull bones, purulent acute and chronic otitis media, mastoiditis, purulent processes in the orbit, paranasal sinuses) along the brain and diploic veins. In addition, phlebitis and thrombosis of the dural sinuses can occur hematogenously with thrombophlebitis of the veins of the extremities or pelvis and during septic processes. Thrombosis of the cerebral sinuses is sometimes accompanied by thrombophlebitis of the retinal veins, purulent meningitis, brain abscesses, etc. Sinus thrombosis can also occur with chronic infections (tuberculosis), malignant tumors and other diseases that occur with cachexia, in debilitated patients and in old age.

Clinical manifestations. Low-grade or sometimes very high, stable or fluctuating body temperature, headache, vomiting, leukocytosis in the blood, increased intracranial pressure. With thrombosis of the sinuses of the convexital surface of the brain, general cerebral symptoms predominate; in the sinuses of the base of the brain, signs of damage to the cranial nerves predominate. Drowsiness develops, sometimes, on the contrary, motor restlessness, insomnia, delirium, epileptic seizures, rigidity of the neck muscles, Kernig's symptom, hyperesthesia to visual, auditory and skin stimuli, and sometimes trismus. Focal symptoms of brain damage correspond to the location of the sinus. Swelling and cyanosis of the face or mastoid area are noted. In the fundus, dilated veins and swelling of the optic discs are detected. The cerebrospinal fluid is clear or xanthochromic, sometimes with an admixture of red blood cells; moderate pleocytosis is noted. Septic thrombosis of the dural sinuses is manifested by chills and very high remitting temperature. With thrombosis of the superior sagittal sinus, epileptic seizures of the motor type, hemi- and paraplegia or paresis occur.

Symptoms of thrombosis of the transverse or sigmoid sinus: headache, bradycardia, sometimes double vision, septic temperature, chills, stupor, turning into a soporous and even comatose state, sometimes delirium and agitation, anti-pain position of the head with an inclination to the painful side, meningeal phenomena, leukocytosis in blood. The jugular vein may be involved in the process. In this case, swelling of the tissue surrounding the vein and signs of damage to the glossopharyngeal, vagus, accessory and hypoglossal nerves occur.

Symptoms of cavernous sinus thrombosis: exophthalmos, swelling and venous hyperemia of the eyelids, orbits, forehead, root of the nose, dilation of the fundus veins (congestion), pain and hyperesthesia in the area of ​​innervation of the superior branch of the trigeminal nerve, chemosis of the conjunctiva, ophthalmoplegia - paralysis or paresis of muscles, innervated by the III, IV, VI cranial nerves, stupor, delirium, sometimes coma, metabolic and endocrine dysfunction.

Complications: purulent meningitis, metastatic abscesses in the lungs, septic pneumonia.

Thrombophlebitis of the cerebral veins. With thrombophlebitis of the cerebral veins, the temperature rises to subfebrile levels with periodic rises to 38–39 °C. Patients complain of headache, nausea, and vomiting. Observed stupor, stuporous state, epileptic seizures, paresis of the limbs; in the fundus – swelling and dilation of veins; in the blood - leukocytosis; in the cerebrospinal fluid - slight pleocytosis, an increase in the amount of protein and positive protein reactions, sometimes an admixture of erythrocytes.

Segments

What is PMA of the brain? ACA stands for anterior cerebral artery in medicine. The blood supply to the brain is quite complex. Blood enters the brain through two internal carotid and two vertebral arteries. The carotid arteries form the carotid basin. They begin in the chest cavity: the right one from the brachiocephalic trunk, the left one from the aortic arch. The vertebral arteries form the vertebrobasilar basin. Through them, blood flows into the vessels that provide nutrition to the medulla oblongata, cervical spinal cord and cerebellum. As a result of fusion, the vertebral arteries form the main basilar artery.

The ACA (anterior cerebral artery) begins at the site where the internal carotid artery divides into its terminal branches. At the beginning of its journey, it gives off a number of small branches that penetrate through the anterior perforated substance to the basal nuclei of the base of the cerebrum. At the level of the optic chiasm, the anterior cerebral artery forms an anastomosis (ostium) with the artery of the same name on the opposite side through the anterior communicating artery.