Discussion:
Embryological developmental abnormalities cause vascular malformations. Hemangiomas fade away over time. However, vascular abnormalities can grow and last a lifetime. Even though vascular abnormalities are present at birth, they might not have been discovered until adolescence or the elderly (5). Venous abnormalities are generally asymptomatic and typically occur in the head and neck region (6).
Congenital agenesis of the IJV is a very unusual occurrence (3). The CT imaging of an instance of IJV agenesis is described in this article. Early detection can help limit damages during medical therapy of neurological conditions, including headaches, and avoid misdiagnosis and other prevalent diagnoses. The IJVs are the prominent venous outflow veins in the brain. In a patient with congenital agenesis of the IJV, impairment of the alternate pathways of vascular supply from the cranial cavity can have catastrophic repercussions. Embryological developmental abnormalities cause vascular anomalies in the head and neck region, which can persist asymptomatically (7).
IJV passes through the neck’s carotid sheath and behind the clavicle’s sternal end. It then joins the subclavian vein to form the brachiocephalic vein, which travels through the thorax to reach the superior vena cava. Clinically, knowledge of IJV anatomical differences is critical for venous applications. Central catheters are often used in intensive care units. IJV anomalies may prevent the practitioner from performing the procedure, causing significant consequences. To avoid difficulties, the surgeon should conversate with the anatomy and variations of IJV (3).
Different IJV anomalies have been revealed in the scientific literature: partial or total duplication (8, 9), stenosis, complete occlusion, distortions, and intraluminal structures, such as membranes, webs, and inverted valves (10). These are frequently discovered by chance or during neck diagnostic techniques due to a suspicious tumour and are sometimes the consequence of compensatory contralateral IJV enlargement (3). Our case was slightly different because he identified IJV agenesis based on the headache evaluation. Our patient had no prior history of any other illnesses or thrombosis history. There was no thrombosis on ultrasonography, CT, or neuroimaging, and the IJV was congenitally agenesis.
Patients who report to the emergency department frequently complain of headaches. Most of these headaches are harmless, but others have a more organic severe cause. Patients may present with a chronic headache issue that they cannot manage. The history of headache diagnosis is thoroughly addressed, followed by a discussion of headache patients’ emergency presentations. Subarachnoid haemorrhage, meningitis, sinusitis, glaucoma, internal carotid artery dissection, and cerebrovascular illness are the causes for worry and a full explanation of the differential diagnosis. Analgesics, NSAIDs, opioids, and end ergotamine formulations are among the drugs discussed for symptomatic headache treatment. In the emergency service, strategies for treating frequent, chronic headaches keep in mind that agenesis of the jugular venous system can play a role—one of the uncommon causes of headaches that we have seen in our instances. Limitations, more advanced intervention can be used to rule out any linkage between internal jugular vein agenesis and headaches, as well as surgical treatment for this result.