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<meta name="DC.Description" content="Summary: We present an unusual case of a scalp vein detected by using angiography of the internal carotid artery. The vein arose from the superior sagittal sinus and drained into the deep posterior cervical vein via the parietal emissary vein. This scalp vein may be a collateral pathway for venous sinuses; however, the patient had no evidence of venous sinus occlusive disease or intracranial hypertension." />
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<meta name="DC.Contributor" content="Waro Taki" />
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<meta name="og-description" property="og:description" content="Summary: We present an unusual case of a scalp vein detected by using angiography of the internal carotid artery. The vein arose from the superior sagittal sinus and drained into the deep posterior cervical vein via the parietal emissary vein. This scalp vein may be a collateral pathway for venous sinuses; however, the patient had no evidence of venous sinus occlusive disease or intracranial hypertension." />
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      <h1 class="highwire-cite-title" id="page-title">Scalp Vein Detected Using Internal Carotid Angiography that Did Not Result in Venous Sinus Compromise</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Kazuhiro Ohtakara</span>, <span class="highwire-citation-author" data-delta="1">Tadashi Kojima</span> and <span class="highwire-citation-author" data-delta="2">Waro Taki</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">June 2000,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">21 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1032-1033; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-11646--6133960491" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Kazuhiro Ohtakara </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Kazuhiro%2BOhtakara%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ohtakara%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AKazuhiro%2BOhtakara%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Tadashi Kojima </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Tadashi%2BKojima%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kojima%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ATadashi%2BKojima%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Waro Taki </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Waro%2BTaki%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Taki%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AWaro%2BTaki%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view"><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><p id="p-1">Summary: We present an unusual case of a scalp vein detected by using angiography of the internal carotid artery. The vein arose from the superior sagittal sinus and drained into the deep posterior cervical vein via the parietal emissary vein. This scalp vein may be a collateral pathway for venous sinuses; however, the patient had no evidence of venous sinus occlusive disease or intracranial hypertension.</p></div><div class="section" id="sec-1"><p id="p-2">Under normal conditions, opacification of scalp veins on internal carotid angiograms is very unusual <a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">(1, 2)</a>. A scalp vein may be seen as an important collateral pathway in the presence of venous sinus compromise caused by various disorders such as parasagittal meningiomas <a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">(2)</a> or venous sinus thrombosis <a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">(3, 4)</a>. We describe an unusual case of visualization of a scalp vein by angiography of the internal carotid artery that did not result in compromised flow within the intracranial venous sinuses.</p></div><div class="section" id="sec-2"><h2>Case Report</h2><p id="p-3">A 75-year-old woman was referred to our institution with a diagnosis of internal carotid artery aneurysm detected using MR angiography. Her history was unremarkable except for treatment by her local physician for systemic lupus erythematosus 10 years earlier. The neurologic examination showed no abnormalities. Angiography of the internal carotid angiography showed a saccular aneurysm of the left internal carotid artery bifurcation and a well-defined scalp vein (<a id="xref-fig-1-1" class="xref-fig" href="#F1">Fig 1</a>). The scalp vein originated from the superior sagittal sinus and drained into the right, deep, posterior cervical vein via the parietal emissary vein. The flow within the venous sinuses was preserved, although the left transverse sinus was hypoplastic.</p><div id="F1" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/21/6/1032/F1.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Serial venous-phase angiograms of the right internal carotid artery shows a scalp vein arising from the superior sagittal sinus via the parietal emissary vein and draining into the deep posterior cervical vein. The left transverse sinus is hypoplastic. A, C, and E, Towne projections; B, D, and F, lateral projections" class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-2032635836" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;Serial venous-phase angiograms of the right internal carotid artery shows a scalp vein arising from the superior sagittal sinus via the parietal emissary vein and draining into the deep posterior cervical vein. The left transverse sinus is hypoplastic. A, C, and E, Towne projections; B, D, and F, lateral projections&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="fig 1." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/21/6/1032/F1.medium.gif" width="440" height="319"/><noscript><img class="highwire-fragment fragment-image" alt="fig 1." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/21/6/1032/F1.medium.gif" width="440" height="319"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/21/6/1032/F1.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download fig 1." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/21/6/1032/F1.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/36242" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label"><span class="sc">fig</span> 1.</span> <p id="p-7" class="first-child">Serial venous-phase angiograms of the right internal carotid artery shows a scalp vein arising from the superior sagittal sinus via the parietal emissary vein and draining into the deep posterior cervical vein. The left transverse sinus is hypoplastic. <em>A, C,</em> and <em>E,</em> Towne projections; <em>B, D,</em> and <em>F,</em> lateral projections</p><div class="sb-div caption-clear"></div></div></div></div><div class="section" id="sec-3"><h2>Discussion</h2><p id="p-4">Scalp veins occasionally can be seen in the venous phases on angiograms of external and common carotid arteries or by direct injection of the scalp veins <a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">(1)</a>. Under normal conditions, however, opacification of scalp veins on internal carotid angiograms is extremely rare <a id="xref-ref-1-3" class="xref-bibr" href="#ref-1">(1, 2)</a>. Heindrich et al (cited by Yasargil and Damur [3]) reported visualization of frontal emissary veins in only 1% of 4000 carotid angiograms. The parietal emissary vein is usually not shown by normal internal carotid angiograms <a id="xref-ref-1-4" class="xref-bibr" href="#ref-1">(1)</a>. According to Waga and Handa <a id="xref-ref-2-2" class="xref-bibr" href="#ref-2">(2)</a>, abnormal filling of scalp veins may be seen on carotid angiograms under the following conditions: superior sagittal sinus occlusion by parasagittal meningeal tumors and venous sinus thrombosis <a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">(3, 4)</a>, arteriovenous malformations of the scalp, malignant tumors involving the scalp and skull, sinus pericranii, and increased intracranial pressure <a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">(5)</a>. Scalp veins may act as important collateral venous pathways in cases of venous sinus occlusion <a id="xref-ref-2-3" class="xref-bibr" href="#ref-2">(2)</a>.</p><p id="p-5">In the present case, the scalp vein was detected by using internal carotid angiography, whereas neuroimaging examinations revealed no abnormal conditions compromising the venous sinuses. The scalp vein arose from the superior sagittal sinus via the parietal emissary vein and drained into the deep posterior cervical vein. The posterior condyloid vein connects the deep posterior cervical vein with the jugular bulb <a id="xref-ref-1-5" class="xref-bibr" href="#ref-1">(1)</a>. Therefore, this scalp vein may be a possible collateral pathway for venous sinuses in flow-restricting circumstances.</p></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn" id="fn-1"><p id="p-6"><a class="rev-xref" href="#xref-fn-1-1">↵</a><span class="fn-label">1</span> Address reprint requests to Kazuhiro Ohtakara, MD, Department of Neurosurgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.</p></li></ul></div><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-21.6.1032.1"><div class="cit-metadata"><cite>Hacker H.   <strong>Normal supratentorial veins and dural sinuses.</strong>  In: Newton TH, Potts DG, eds. <em>Radiology of the Skull and Brain.</em> vol 2, book 3. St Louis: Mosby  1974 <span class="cit-fpage">1851</span>-1862</cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-other" id="cit-21.6.1032.2"><div class="cit-metadata"><cite>Waga S,  Handa H.   <strong>Scalp veins as collateral pathway with parasagittal meningiomas occluding the superior sagittal sinus.</strong> <span class="cit-source">Neuroradiology</span> <span class="cit-pub-date">1976</span>;<span class="cit-vol">11</span>:<span class="cit-fpage">199</span>-204</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=958623&amp;link_type=MED&amp;atom=%2Fajnr%2F21%2F6%2F1032.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3 in text" id="ref-3">↵</a><div class="cit ref-cit ref-other" id="cit-21.6.1032.3"><div class="cit-metadata"><cite>Yasargil MG,  Damur M.   <strong>Thrombosis of the cerebral veins and dural sinuses.</strong>  In: Newton TH, Potts DG, eds. <em>Radiology of the Skull and Brain,</em> vol 2, book 3. St Louis: Mosby  1976 <span class="cit-fpage">2375</span>-2400</cite></div><div class="cit-extra"></div></div></li><li><div class="cit ref-cit ref-other no-rev-xref" id="cit-21.6.1032.4"><div class="cit-metadata"><cite>Kinal ME.   <strong>Traumatic thrombosis of dural venous sinuses in closed head injury.</strong> <span class="cit-source">J Neurosurg</span> <span class="cit-pub-date">1967</span>;<span class="cit-vol">27</span>:<span class="cit-fpage">142</span>-145</cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5 in text" id="ref-5">↵</a><div class="cit ref-cit ref-other" id="cit-21.6.1032.5"><div class="cit-metadata"><cite>Osterholm JL.   <strong>Reaction of the cerebral venous sinus system to acute intracranial hypertension.</strong> <span class="cit-source">J Neurosurg</span> <span class="cit-pub-date">1970</span>;<span class="cit-vol">32</span>:<span class="cit-fpage">654</span>-659</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=5442591&amp;link_type=MED&amp;atom=%2Fajnr%2F21%2F6%2F1032.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="history-list"><li xmlns:hwp="http://schema.highwire.org/Journal" class="received" hwp:start="1999-10-29"><span class="received-label">Received </span>October 29, 1999.</li><li xmlns:hwp="http://schema.highwire.org/Journal" class="accepted" hwp:start="2000-01-03"><span class="accepted-label">Accepted after revision </span>January 3, 2000.</li></ul><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/21/6/1032.abstract" class="hw-link hw-link-article-abstract" data-icon-position="" data-hide-link-title="0">View Abstract</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 21</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 6 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jun 2000 </div></div>
      
      
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2000, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">21 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1032-1033; </span></div>
  
  
  
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