The Good Doctor; Jugular Stenosis in s7 ep 4

Hi all! I typically do not make posts; I’m more of a silent follower type but I was watching the most recent episode of The Good Doctor and one of the patients had presented with early onset Alzheimer’s. If you watch the show and don’t want spoilers, by all means skip the post, but if you don’t care, please keep reading!

Ultimately, Dr. Shaun Murphy discovers that the patient only has his symptoms positionally and upon rotation of his neck. And in one of his deep thoughts, he thinks about the patient’s C1 compressing the jugular vein and causing the patient’s symptoms. From there, the patient has surgery and his symptoms are resolved. (In true TV magic happily ever after! Haha)

Now obviously, there are a LOT of inaccuracies of symptoms. The patient’s erratic loss of memory for one I think is not grossly accurate to how a lot of us may experience how brain fog, loss of concentration, among other things. I for one have occlusion bilaterally and have extremely difficult days but I have never forgotten the names of my family or my surroundings suddenly. Now, everyone experiences symptoms very differently and everyone has very diverse symptomatology, but this was an odd choice to go with. I didn’t quite know how to feel as a patient myself watching the show. But I know it’s TV and of course it’s dramatized. So we have to take it with a grain of salt. If anyone has any feedback, I’d love to hear it! Depending on comfort level of course!

I also disappointed that they chose this diagnosis and then not go into much detail about the procedure itself. Sometimes the show does this, but I think it would’ve been great to have a nice mention of the surgery, since so many in the community often don’t see ourselves in mainstream media often. As someone who works in healthcare, I do find procedures interesting, and maybe people would disagree with me, but having the surgery itself can be just as important too.

So I would love to hear everyone’s feedback about this! From people who watch the show and don’t, but it’s great that they depicted this in general. It’s time medical shows like this got our condition out there. When I even explain it to people outside my family, I feel so self conscious. So it’s nice to have another avenue to even get the point across. Any support is something!

Thank you for hearing me out! I love hearing from the community and everyone is so helpful! I appreciate everyone and I hope this point brings great feedback! If this is not appropriate in any way, please delete it. Totally understand and I want to be respectful of community rules! :slight_smile:


Thanks for posting this, very interesting… understandable to get extreme symptoms positionally with carotid arterial compression, but I would’ve thought unusual with IJV compression. Certainly for me it was a build up of pressure & brain fog, other than increased pressure with laying flat, position didn’t seem to make much difference. Although I think others have noticed positions affecting them more…
Like you say (without watching, not sure if we can see it in the UK) it’s a shame they didn’t show more of the surgical intervention.
Glad you posted :smiley:


In my case, the worst brainfog episodes used to be quite bad. Memory issue including.


Yes Jules, you make an excellent point about the carotid variant of jugular stenosis! They specifically depicted the jugular being compressed. So yeah it would’ve made more sense to do the carotid variant as they can have stroke and other complications that would have more similar symptoms to “early onset Alzheimer’s” that they were trying to depict in the episode. But even then I don’t think it is quite an accurate representation of what we go through.

When my intracranial pressure goes up and my migraines are at its worst, my memory is significantly bad. But, they were trying to show that the character was loosing all awareness of his wife, surroundings, dates, etc. to the point that they were recommending to put him in a skilled nursing facility. And then suddenly, he would remember everything all over again. And then not. It was just too erratic to not what I feel is what a true IIH, intracranial migraine experience was like in my perspective! But I totally understand if others feel quite differently! Hence why the post! I don’t want to invalidate others experiences at all.


To be honest, transient IJV compression is capable of causing transient severe IIH. Severe IIH is like concussion, so I’d suspect that can cause quite debilitating cognitive issues.

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@mspicer426894 - Good to hear from you & thank you for sharing the info about The Good Doctor episode. I haven’t seen the show either, but I agree with what you, @Jules & @vdm have said. There is much we don’t know about vascular compression, & the symptoms it can cause so, as vdm noted, the scenario presented might be possible.

It sounds like you haven’t had surgery yet for your situation. Is that something you’re contemplating having done or are you able to manage your symptoms sufficiently that there isn’t a pressing need?

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In my case, I am having surgery. My first surgery is in a few weeks! It’s been a long time coming and I am really looking forward to it, as I’ve been on medication for quite sometime (much like everyone here) to no success. My current migraine cocktail of topamax, aimovig, and ubrelvy can only go so far. Was on Diamox prior but it made me so sick, much like others here I’m sure. I am having both sides done but I am doing one side at a time. I unfortunately am not a candidate for stenting as I am highly allergic to the materials in stents so I am very much hoping the relief of my styloids and a C1 shave will help! Since I’m my situation, both seem to be the problem for me. :joy: my jugulars is sort of pancaked by them. Maybe when I become braver I’ll make a separate post with my CTA 3D images! This forum helped me make those awhile back and they were so helpful when showing them to Dr. H and Dr. C and others in the consulting phases. They were very impressed by them! So thank you all for that! Your work does not go unnoticed by the doctors at all!


I’m so pleased that you have a date for surgery! Who will be doing it? Will pray that all goes well for you :hugs:


My cerebral angiogram/venogram showed C1 compression issues at different provoked head movements.

It’s funny that you bring this up. I often told my husband I felt like I was experiencing cognitive decline. I would get very confused and there were a few times I was so confused I cried because I knew my brain wasn’t working right. I didn’t forget anyone, but I forgot a lot of simple things. One time my husband had left the house to drop my son off at school and I walked around the house looking for him and talking to him - I even thought he was hiding from me - for about twenty minutes until I realized he had left a while ago. I would get very confused driving, but luckily I knew enough to plug my destination into my smartphone so I could get home or to wherever I was going.

I had my surgery on one side and the brain fog is noticeably better. Definitely an interesting direction for the show to go and a little over the top - but the biggest thing that the surgery relieved for me was brain fog. And my brain fog was pretty scary at times.


I’m glad that surgery has helped with your brain fog @ectocake , that sounded really scary!

Yes I saw it and was pleasantly surprised. It’s a start to be recognized. The brain fog and forgetfulness is horrible


Who’s doing your surgery?