This fact is usually not mentioned in literature regarding headache research (Fig. 2). In a group of children with headaches caused by cerebral venous dysfunction, 88 children had different structural abnormalities (confirmed by
MRI): 46 of them had abnormalities of craniovertebral junction (Chiari abnormalities I). 42 children PFT�� supplier had abnormalities of deep brain veins. Hypoplasia of transverse sinuses combined with hypoplasia of sigmoid sinuses was revealed in 36 children, hypoplasia of the superior sagittal sinus in 3 children, and Chiari abnormality in 5 children (Fig. 3). The clinical picture of children with structure abnormalities was characterized by headaches (100%), nasal bleeding (60%), sickness and vomiting (40%), noise in ears (35%), dizziness (30%), vegetative dysfunction, 1% of children had relative deafness, and 8% of children had tics Talazoparib mw (mostly of face muscles). All examined children complained of headaches localized in cervical and parietal regions, that arised while or after night/day sleeping. Increase of headaches occured after physical exercises, and lessons at school. 60% of children had typical nasal bleeding, mostly abundant and spontaneous
as a “fountain” (Fig. 4). As a result of the research we revealed an increase of velocity in deep brain veins (peak systolic velocity—VPS): in the straight sinus 56 ± 5.6 cm/s, and in the great cerebral vein of Galen 57 ± 9.4 cm/s (our
normal values were 26 and 22 cm/s, respectively). An increase of blood flow velocity in vertebral venous plexus was also registered (not registered regularly) (Fig. 5). Considering the difficulties of localizing the cavernous sinus using the transorbital access in children (especially in younger ones), we applied a new technology of evaluating the cavernous sinus by transcranial duplex scanning. This allows to determine the structure and features of the cavernous sinus and blood flow in eye veins. Disturbances of venous outflow in the cavernous sinus have been revealed in 68% of children by TCCD (Fig. 6). Ultrasonic data in children with structural cerebral abnormalities was in accordance with MRI findings (Fig. 7). The conservative treatment which has been Urocanase performed under ultrasonographic control (TCD, TCCD) in children with disturbances of cerebral hemodynamics, led to subjective and objective improvement in 85% of children. We recommend ultrasonic methods not only for diagnostics of cerebral venous disturbances, but also for follow-up of the therapy. Clinically, the frequency and intensity of headache, nasal bleeding, dizziness, nausea and vomiting were reduced after the treatment (up to total disappearance of symptoms) (Fig. 8). Features of cerebral hemodynamics causing disturbances of venous outflow are described in cases of abnormalities of craniovertebral junction and deep brain veins.
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