High Julgular Bulb in Brain Causing Meniere's-Like Symptoms

I recently had an MRA (MRI of arteries- brain/neck) that had a rather interesting finding. Apparently, I have a high jugular bulb on my most symptomatic side. The radiologist told me this can cause Meniere's-like symptoms, although a very small percentage of "normal" people (3%) have this and don't suffer any problems.

I guess one is not born with a HJB, but it can develop as one ages and usually makes an appearance by age 50. Not sure if this has been discussed here before, but thought I would mention it as it was new information to me.

In my case, the neuro-radiologist specialist is on vacation, but he will look at my images when he returns as it was a run-of-the-mill radiologist who read the report. Hopefully, he will be able to tell me if this is worth looking into in my particular case.

I'm hoping RedBird sees this as I ran across a case study of someone who experienced intermittent one-side facial palsy as well as Meniere's-like symptoms.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134823/

http://www.ncbi.nlm.nih.gov/pubmed/24647494

 

I really don't know that much about it myself. However, when my symptoms first started over two years ago, I had a CTA (A CT scan of the arteries in my neck and brain), and I was told everything was normal. I have read that the HJB can develop/worsen over time and that particular blood vessel is highly susceptible to changing position (my interpretation of quickly read material). I was told it is plausible that my aggressive sit-ups, yanking up my head and neck repeatedly may have started its formation.

The imagining I just had done was a regular MRI of the brain and then also an MRA, which is a special MRI looking specifically at the blood vessels that run through the neck and brain. Interestingly, the radiologist who initially read the report didn't mention the unilateral high jugular bulb at all. However, my husband asked a radiologist colleague of his to look over the pictures, and he was the one who said it jumped right out to him. (He said when he reads these images in someone who describes headache, pulsatile tinnitus and vertigo, he always looks specifically for a HJB.) I'm not sure why the first radiologist didn't mention it. Once it was pointed out to me on-screen, even I could see a dramatic difference in the two sides.

It will be interesting to see if the neuro-radiologist has the same impression.

I haven't had time to do much reading about it, but a couple papers I skimmed over said that a HJB may be a suspect in a great number of Meniere's cases.

Finally, is the moderator able to correct my spelling of the word "Jugular" in the title of the original post? I don't believe I can do that.

 

A couple more interesting "abstracts":

http://link.springer.com/article/10.1007%2Fs00405-014-3063-x

We have read the article by Park et al. “Jugular bulb abnormalities in patients with Ménière’s disease using high-resolution computed tomography” with great interest. In this study, the authors demonstrated that 21 % of patients with Ménière’s disease exhibited jugular bulb abnormalities (JBA), but with no significant increase in vestibular aqueduct dehiscence. We agree with the authors who conclude in an association, but no causality, between Ménière’s disease and JBA. Nonetheless, other studies have described Ménière-like syndromes caused by vestibular aqueduct dehiscence induced by JBA [1, 2]. Importantly in these cases, efficient treatment can be proposed that is either surgical [3] or endovascular [2]. It is then important to differentiate between which vestibular aqueduct dehiscences are responsible for the Ménière-like syndromes, and which are fortuitous associations. To do so, the surgeon must look for four clues indicating that the vestibular dehiscence is symptoma

and:

http://www.researchgate.net/publication/259499518_New_Treatment_of_Vertigo_Caused_by_Jugular_Bulb_Abnormalities

New Treatment of Vertigo Caused by Jugular Bulb Abnormalities.
12:23 EDT 18th July 2014 | BioPortfolio
Home » Citations » Surgical innovation » New Treatment of Vertigo Caused by Jugular Bulb Abnormalities.
Summary of "New Treatment of Vertigo Caused by Jugular Bulb Abnormalities."

Objective. Jugular bulb abnormalities can induce tinnitus, hearing loss, or vertigo. Vertigo can be very disabling and may need surgical treatments with risk of hearing loss, major bleeding or facial palsy. Hence, we have developed a new treatment for vertigo caused by jugular bulb anomalies, using an endovascular technique. Patients. Three patients presented with severe vertigos mostly induced by high venous pressure. One patient showed downbeat vertical nystagmus during the Valsalva maneuver. The temporal-bone computed tomography scan showed a high rising jugular bulb or a jugular bulb diverticulum with dehiscence and compression of the vestibular aqueduct in all cases. Intervention. We plugged the upper part of the bulb with coils, and we used a stent to maintain the coils and preserving the venous permeability. Results. After 12- to 24-month follow-up, those patients experienced no more vertigo, allowing return to work. The 3-month arteriographs showed good permeability of the sigmoid sinus and jugular bulb through the stent, with complete obstruction of the upper part of the bulb in all cases. Conclusion. Disabling vertigo induced by jugular bulb abnormalities can be effectively treated by an endovascular technique. This technique is minimally invasive with a probable greater benefit/risk ratio compare with surgery.

 

That's interesting, nicmger, about your jugular. The way I understand it (and I'm no expert ) is that the jugular vein runs through the neck up into the head. The part of the jugular vein in the head runs very close to the inner ear and drains blood/fluid away from the brain. If a jugular bulb is too high up in the head it can actually intrude upon the inner or middle ear.

The theory, I believe, is that a high riding jugular bulb can push against the vestibular aqueduct and prevent the endolymph from draining properly thus leading to hydrops. I believe they can also cause dehiscence of the inner ear structure as well. Once again, not an expert here... just passing along what I understood from the radiologist.

 

My understanding is that in the majority of people, one jugular bulb is bigger than the other, so I don't believe that is the issue. The concern is more where the bulb ends up. Perhaps by a "spur" they meant a diverticulum? I have read articles discussing a diverticulum (out-pouching) of the jugular bulb that can intrude on the middle or inner ear causing symptoms. And, I understand that a high jugular bulb (and a diverticulum) forms over time, but is usually done forming/moving by the age of 50. It's a dynamic structure that is not anatomically stable. It's progressively molded by hemodynamic forces. So, even though you've had the same jugular veins since birth, the bulb moves and can form an out-pouching as one ages.

 

Okay, my MRA was read today by the neuro-radiologist. He does not think I meet the criteria for a HJB. So... ruled-out. Nonetheless, I hope the information posted will be of help to someone on this board.