To determine the correlation between extracranial venous compression and persistent oscillating vertigo (POV).

POV described as a rocking/bobbing/swaying perception can be triggered by motion (mal de debarquement syndrome-MdDS) or occur without a motion trigger. It is not known what causes non-motion triggered POV (nmPOV). nmPOV has a higher association with migraine headache, occurs at a younger age, and is less responsive to treatment than MdDS. Underlying structural disorders leading to nmPOV may include extracranial venous compression.  

Case series of clinic patients presenting with nmPOV screened with quantitative flow measurements of the internal jugular and subclavian veins followed by CT venograms in symptom exacerbating positions.

Ten patients with nmPOV (8 female/2 male age range 31-78 years) were seen over the course of one year. In addition to the vertigo, all patients had headache described as head pressure. Two patients had evidence of venous thoracic outlet syndrome; both improved with physical therapy directed toward 1st rib mobilization. Seven patients had severe jugular vein compression at the skull base between the styloid process, transverse process of C1, and posterior belly of the digastric muscle. One had focal stenosis of the internal jugular vein in the mid-neck. Three jugular vein stenosis patients have had surgery to date. One had resolution of POV and other symptoms (spinning vertigo, tinnitus, tachycardia) with bilateral resection of the styloid processes. The other two patients, both women in their 70’s, did not achieve a decompression from the surgery (styloid resection in one, a vein graft in the other) and had persistent symptoms. Other surgical outcomes are pending.

Extracranial venous compression may be an underlying structural cause of nmPOV which may be a form of pulsatile vertigo. Treating the underlying structural disorder may be beneficial with physical therapy or surgery but decompression may not be achievable in some patients.