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Join Date: Sep 2006
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Member
Join Date: Sep 2006
Posts: 292
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http://tosinfo.com/mri/images/jnma_tos_article_0403.pdf you might want to copy/paste this into the address if it won't come up for you let me know
and I got this from Our Dear OCGirl 
The Role of Bicuspid Valves in Costoclavicular
Venous Compression in Patients with thoracic
Outlet Syndrome (TOS)
Poster submission
Ernestina H. Saxton; James D. Collins; Theodore Q. Miller;
Samuel S. Ahn; A. Carnes. Los Angeles, CA
The circulatory system is a closed system.
Compression of any peripheral vein decreases
venous return, and increases intrathoracic, intraabdominal,
and intracranial pressures. Veins contain
bicuspid valves along their course to assist and direct
blood flow, and divert pressure into other veins and
the lymphatics. Every vein has a bicuspid valve proximal
to its junction with another vein. Compression
of the bicuspid valves diminishes and/or obstructs
venous and lymphatic return to the heart; veins and
lymphatics dilate and tissues from whence they came
expand (edema). Ischemia develops, and, if not
relieved, tissue damage follows. Veins are compressed
in patients with TOS. This results in patients’
complaints of numbness, tingling, pain of the upper
and lower extremities, headache, back and face pain,
visual symptoms, incoordination, syncope, and
weakness. Monitored multiplanar bilateral MRI,
MRA and MRV display sites of bicuspid valve compression
in patients with brachial plexopathy and
TOS. Patients were imaged on the 1.5 Tesla GE Signa
MRI unit, 4.0-mm thickness, with saline water bags
beside the neck to enhance signal-to-noise ratio. This
presentation displays the sites of bicuspid valves
within the internal and external jugular; subclavian
and cephalic veins in the neutral position and sites of
compression in stressed position. It also displays role
of the vertebral veins in collateral circulation with
costoclavicular compression.
Transient Ischemic Attack (TIA) Symptoms
Caused by Costoclavicular Venous
Compression in Patients with Thoracic Outlet
Syndrome (TOS): MRI/MRA
Poster submission
James D. Collins; Ernestina H. Saxton; Theodore Q. Miller;
Samuel S. Ahn; A. Carnes. Los Angeles, CA
Transient ischemic attack (TIA), usually thought
of as a sudden focal loss of neurological function with
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 95, NO. 8, AUGUST 2003 683
ABSTRACTS
complete recovery usually with 24 hours, is caused by
a brief period of inadequate perfusion of the brain in
the territories of carotid and vertebral basilar arteries.
Patients with thoracic outlet syndrome (TOS) present
with TIA-like symptoms: visual scotomata, double
and blurred vision, vertigo-dizziness, tinnitus, slurred
speech, incoordination/abnormal gait, numbness,
syncope, and headache. Electromyography/nerve
conduction studies, (EMG/NCV), routine x-rays, CT,
MRI/ MRA, and cerebral angiography are negative.
Monitored bilateral multiplanar MRI, MRA and
MRV on the 1.5 Tesla GE MRI unit display costoclavicular
compression of the bicuspid valves within
the draining veins of the neck, shoulders, and the
upper extremities that trigger the same complaints
that occur in patients with TIA, particularly in the
abduction external rotation (AER) of the upper
extremities. This presentation displays enhanced costoclavicular
compression with AER of the bicuspid
valves within the internal jugular and subclavian
veins and collateral venous return through vertebral,
cephalic, and anterior jugular veins—triggering TIA
complaints. Since the circulatory system is a close
system, compression of the neck veins significantly
impairs cerebral venous drainage and triggers TIA
compliants.
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