Incidence of dynamic internal jugular vein stenosis during cerebral venography: an updated analysis

OBJECTIVE: The aim of this study was to characterize internal jugular vein (IJV) physiology across multiple head positions in patients undergoing evaluation for suspected cerebral venous outflow disorders (CVDs) and to expand prior work by presenting the largest dynamic cerebral venography and pressure manometry series to date. METHODS: A retrospective chart review was conducted on patients who underwent diagnostic cerebral venography with pressure manometry and rotational analysis between 2024 and 2025. Venography and manometry were performed in neutral, 90° rightward rotation, 90° leftward rotation, and chin flexion head positions for each IJV. The degree of stenosis was graded and the transstenotic pressure gradients were recorded. RESULTS: A total of 223 consecutive patients underwent diagnostic cerebral venography with pressure manometry during the study period. Ninety-four percent of patients developed at least moderate rotational stenosis with ipsilateral or contralateral head rotation and 84% developed severe or occlusive stenosis with head rotation in at least 1 IJV. Chin flexion resulted in severe or occlusive stenosis in 74% of the IJVs studied in this series. A rotational gradient of at least 6 mm Hg was found in 43.5% of patients, and 17.5% of patients had a gradient of at least 10 mm Hg. Contralateral head rotation resulted in stenosis predominately centered at C1, while ipsilateral head rotation resulted in stenosis predominately centered at C2-4. CONCLUSIONS: Dynamic, position-dependent IJV stenosis is highly prevalent in patients evaluated for CVDs, often with large associated pressure gradients. These findings confirm and extend prior observations, highlight the consistent anatomical patterns of compression, and underscore the value of incorporating dynamic positional testing into routine diagnostic evaluation.