Does thoracic outlet syndrome cause cerebrovascular hyperperfusion? - Diagnostic markers for occult craniovascular congestion, Larsen et al. 2019

https://www.researchgate.net/public..._markers_for_occult_craniovascular_congestion

Abstract

Thoracic outlet syndrome (TOS) is known to be associated with diffuse craniological comorbidities (CCM), such as occipital headaches, migraines, vestibular dysfunction, tinnitus and fatigue. Conventionally, these problems have been suggested to be a manifestation of positional vertebrobasilar insufficiency.

Angiography tends to be normal in TOS sufferers, however, and doppler ultrasonography of the vertebral artery fails to demonstrate severe flow reduction. TOS is attributed to the brachial plexus and subclavian artery being compressed in the interscalene triangle, costoclavicular or subpectoral passages. The vertebral and carotid arteries arise from subclavian artery proximal to the sites of obstruction in TOS.

Numerous reports of resolved CCM post scalenectomy and first-rib resection, despite lacking vertebral artery impairment, have been documented. TOS CCM, moreover, share many of the symptoms seen in systemic and intracranial hypertension. Reports of subclavian thromboembolus migrating to the head have been documented in incidences of TOS, showing the potential for flow retrogradation.

We postulate that the blood prevented from entering the brachium due to distal subclavian compression, retrogrades to the brain via the carotid and vertebral arteries, resulting in craniovascular hyperperfusion and congestion.

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https://www.researchgate.net/public..._markers_for_occult_craniovascular_congestion

mechanism:

similarities to ME/CFS:

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Thanks for sharing @borko2100 -- I was diagnosed with TOS a few years ago and will bring this to my doctor's appointment this week.

 

Glad to be able to help. I think the paper's theory is not that far fetched. After all if the blood cannot go to the arms it has to go somewhere, so if it goes to the brain instead, it might indeed cause some problems. Just my opinion as a layman, I hope some others with more expertise will chime in.

I also realized I might have this condition as well, considering I have had almost constant low grade pain / burning / warmth sensation in my hands since 2019. I also experience the majority of the cranial symptoms mentioned by the paper.

 

Over the past year, I have had many consultations with the author of this paper who diagnosed me with TOS-CVH.

Subjectively, the diagnosis bears out in my personal experience. I always get much worse after common TOS triggers, such as washing my hair and doing any overhead work. And exertion of the scalenes using a targeted exercise increases my symptoms dramatically. I could literally feel the blood pulsing towards my head. My main symptoms are fatigue, head heaviness and head pressure.

I have put forth much effort in trying to fix this problem with conservative measures by trying to strengthen the super weak scalenes and other musculature in the neck. However this has proven difficult, painful and impossible. Thus, I have started to seriously consider a scalenectomy and first rib resection, the surgical option for TOS.