Dynamic jugular stenosis can occur with minimal head rotation and worsens with progressively greater rotation.

Abstract

Dynamic internal jugular vein (IJV) stenosis has been demonstrated with 90 degree head rotation, often producing large trans-stenotic pressure gradients and elevations in intracranial venous pressures. However, the prevalence of IJV stenosis and occlusion with partial head rotation remains unknown. This retrospective, multi-institutional study included patients with suspected cerebral venous outflow disorders that underwent diagnostic cerebral venography with pressure manometry across progressive head rotations (neutral, 25 degrees, 45 degrees, and 90 degrees bilaterally). Superior sagittal sinus and IJV pressures were recorded, and the degree of IJV stenosis and associated pressure gradients were quantified. Twenty patients underwent cerebral venography and pressure manometry with fractional head rotation. The mean age of the patients in this cohort was 43.4 years, and 70% of the patients were female. Severe or occlusive stenosis occurred in 15-20% of patients at 25 degrees of ipsilateral head rotation, 40% of patients at 45 degrees of ipsilateral head rotation, and 70-80% of patients at 90 degrees of ipsilateral head rotation. The highest median pressure gradient occurred with ipsilateral 90 degree head rotation in both the right and left IJV, measuring 6.0 mmHg and 5.0 mmHg respectively. Trans-stenosis pressure gradients and superior sagittal sinus pressures increased in a stepwise fashion with greater degree of head rotation. Fractional head rotation frequently produces IJV stenosis and significant pressure gradients. Even modest head turns can precipitate severe stenosis and increased intracranial venous pressures, suggesting that dynamic jugular stenosis and occlusion may play a greater role in daily symptom exacerbation than previously recognized.