OBJECTIVES: Condition known as chronic cerebrospinal venous insufficiency 
(CCSVI) is characterized by insufficient cerebral vein drainage in patients with 
multiple sclerosis (MS) and internal jugular vein (IJV), vertebral and/or azygos 
veins stenoses. However, external compression on the IJV was not clearly 
described as a potential cause of CCSVI. We aim to present a case of CCSVI in a 
patient with MS caused by bilateral IJV inverted valves combined with IJV 
external compression by carotid bulb.
METHODS: A 31-year-old female patient was admitted to our institute for IJV and 
vertebral veins morphological and haemodynamical assessment after being treated 
for MS for the last 14 years. Colour Doppler ultrasonography showed right IJV 
prestenotic dilation and inverted valves in both IJV. Computerized tomography 
angiography showed bilateral IJV compression by carotid bulb. Haemodynamical 
Doppler parameters showed that external IJV compression significantly 
contributed to CCSVI occurrence.
RESULTS: Bilateral IJV confluence percutaneous angioplasty (PTA) was done, and 
the patient was discharged for further neurological examination. Partial carbon 
dioxide pressure was significantly lower in the distal part of both IJV 
following PTA and oxygen saturation increased.
CONCLUSION: In the case presented, PTA of the IJV confluence resulted in 
haemodynamic improvement despite the presence of IJV external compression.