Abstract DP293: Dynamic Jugular Compression from Head Positioning Maneuvers Impacts Cerebral Venous Pressure Profiles

Introduction: Persistent intracranial venous congestion is a debated hypothesis underlying refractory symptoms in idiopathic intracranial hypertension (IIH), driven by: (1) elevated central venous pressures (CVPs) from obesity or cardiopulmonary etiologies—supporting the observed effectiveness of bariatric surgery in relieving IIH symptoms; and (2) jugular compression, which may simulate elevated CVP by impairing cerebral venous outflow despite normal CVP. Head tilting can induce dynamic jugular compression, resulting in elevated intracranial and dural venous sinus pressures during these positions. Methods: We enrolled patient scheduled to undergo diagnostic venograms, with or without VSS, for suspected or confirmed IIH were retrospectively screened. Venous manometer readings were gathered bilaterally along the sinuses and superior and inferior vena cava across three head positions: neutral, tilting right, and tilting left. The following pressure gradients were calculated: overall, total cranial, and transverse-sigmoid or trans-stenosis. Additionally, venous diameters were measured using 2D venograms. VSS was performed in patients with confirmed IIH diagnoses, adhering to an 8mmHg gradient threshold. Results: We included 39 patients. Venous pressures increased with head tilt in both directions, more prominently with rightward tilt (Table 1). With right tilt, superior sagittal, transverse, and sigmoid sinus pressures rose by 22.3% [17.9–26.6], 19% [14.5–24], and 13% [10.5–18.5], respectively. With left tilt, corresponding increases were 20.8% [15.5–27.1], 17.5% [14–23.5], and 13% [10.5–17]. No significant differences were observed across the transverse–sigmoid junction. Conclusion: Head position significantly affects cerebral venous pressures, trans-stenosis gradients, and intracranial pressures in patients with CVD or intracranial hypertension. These findings highlight the need for dynamic venography in the diagnostic evaluation of these conditions to better understand their pathophysiology and improve treatment strategies.