Cerebral venous pressures, sinus trans-stenosis gradients, and intracranial pressures are dramatically augmented by head position.

Background: Cerebral venous pressures, sinus trans-stenosis gradients, and intracranial pressures are thought to be influenced by head position.

Objective: To investigate the intracranial manifestations of these changes in patients with cerebral venous outflow disorders (CVD).

Methods: A retrospective chart review was conducted on 22 consecutive adult patients who underwent diagnostic cerebral venography with rotational internal jugular vein (IJV) venography and superior sagittal sinus (SSS) pressure measurements in multiple head positions. Data on venous sinus pressures, IJV pressures, and lumbar puncture (LP) opening pressures (OP) were collected and analyzed.

Results: The study found that 21 (96%) patients experienced increases in SSS pressures with head rotation, with a mean increase of 25.4%. Intracranial trans-stenosis gradients showed significant variability with head position. Additionally, LP OP measurements increased by an average of 44.3% with head rotation. Dynamic IJV stenosis was observed in all patients during rotational testing.

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.