Influence of Acute Jugular Vein Compression on the Cerebral Blood Flow Velocity, Pial Artery Pulsation and Width of Subarachnoid Space in Humans

Frydrychowski, Andrzej F.; Winklewski, Paweł J.; Gumiński, Wojciech

doi:10.1371/journal.pone.0048245

Cited by 40 publications

(31 citation statements)

References 37 publications

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“…Authors using cine phase magnetic resonance imaging (MRI) to visualise CSF dynamics in the aqueduct of Sylvius also confirmed earlier report by our group that impaired jugular outflow augments CSF pulsatility [36,37]. This study is in line with Chen et al [8] and Dreha-Kulaczewski et al [9] MRI reports indicating that respiration is one of the major regulators of human CSF flow.…”

Section: Discussionsupporting

confidence: 89%

Increased inspiratory resistance affects the dynamic relationship between blood pressure changes and subarachnoid space width oscillations

et al. 2017

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Background and objectiveRespiration is known to affect cerebrospinal fluid (CSF) movement. We hypothesised that increased inspiratory resistance would affect the dynamic relationship between blood pressure (BP) changes and subarachnoid space width (SAS) oscillations.MethodsExperiments were performed in a group of 20 healthy volunteers undergoing controlled intermittent Mueller Manoeuvres (the key characteristic of the procedure is that a studied person is subjected to a controlled, increased inspiratory resistance which results in marked potentiation of the intrathoracic negative pressure). BP and heart rate (HR) were measured using continuous finger-pulse photoplethysmography; oxyhaemoglobin saturation with an ear-clip sensor; end-tidal CO2 with a gas analyser; cerebral blood flow velocity (CBFV), pulsatility and resistive indices with Doppler ultrasound. Changes in SAS were recorded with a new method i.e. near-infrared transillumination/backscattering sounding. Wavelet transform analysis was used to assess the BP and SAS oscillations coupling.ResultsInitiating Mueller manoeuvres evoked cardiac SAS component decline (-17.8%, P<0.001), systolic BP, diastolic BP and HR increase (+6.3%, P<0.001; 6.7%, P<0.001 and +2.3%, P<0.05, respectively). By the end of Mueller manoeuvres, cardiac SAS component and HR did not change (+2.3% and 0.0%, respectively; both not statistically significant), but systolic and diastolic BP was elevated (+12.6% and +8.9%, respectively; both P<0.001). With reference to baseline values there was an evident decrease in wavelet coherence between BP and SAS oscillations at cardiac frequency in the first half of the Mueller manoeuvres (-32.3%, P<0.05 for left hemisphere and -46.0%, P<0.01 for right hemisphere) which was followed by subsequent normalization at end of the procedure (+3.1% for left hemisphere and +23.1% for right hemisphere; both not statistically significant).ConclusionsIncreased inspiratory resistance is associated with swings in the cardiac contribution to the dynamic relationship between BP and SAS oscillations. Impaired cardiac performance reported in Mueller manoeuvres may influence the pattern of cerebrospinal fluid pulsatility.

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Section: Discussionsupporting

confidence: 89%

Increased inspiratory resistance affects the dynamic relationship between blood pressure changes and subarachnoid space width oscillations

et al. 2017

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“…The high within- and between-subject reproducibility and repeatability of NIR-T/BSS measurements have been demonstrated previously [10], [12], [13], [16], [32]. NIR-T/BSS, like NIRS, allows for direct within-subject comparisons [16], [35].…”

Section: Discussionmentioning

confidence: 68%

“…In a healthy population, there are no significant differences between hemispheres (i.e. the cc-TQ ratio between the left and right hemispheres was very close to 1.0) [32]. We hypothesized that cc-TQ may serve as a discriminating factor.…”

Section: Discussionmentioning

confidence: 95%

“…In the first group a moderate increase in CBF and CBV combined with a decrease in sas-TQ and TTP suggests elevation of intracranial pressure, which represents a typical response to acetazolamide challenge [9]. In the second group the substantial increase in cc-TQ, CBF and CBV combined with insignificant changes in sas-TQ and TTP may reflect hyperkinetic circulation without significant change in intracranial pressure [32]. Intracranial pressure might already have been elevated in this group before the acetazolamide challenge due to adaptation to high blood pressure.…”

Section: Discussionmentioning

confidence: 99%

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Near-Infrared Transillumination Back Scattering Sounding—New Method to Assess Brain Microcirculation in Patients with Chronic Carotid Artery Stenosis

et al. 2013

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PurposeThe purpose of the study was to assess the responses of pial artery pulsation (cc-TQ) and subarachnoid width (sas-TQ) to acetazolamide challenge in patients with chronic carotid artery stenosis and relate these responses to changes in peak systolic velocity (PSV), cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to peak response (TTP).MethodsFifteen patients with carotid artery stenosis ≥90% on the ipsilateral side and <50% on the contralateral side were enrolled into the study. PSV was assessed using colour-coded duplex sonography, CBF, CBV, MTT and TTP with perfusion computed tomography, cc-TQ and sas-TQ with near-infrared transillumination/backscattering sounding (NIR-T/BSS).ResultsBased on the ipsilateral/contralateral cc-TQ ratio after acetazolamide challenge two groups of patients were distinguished: the first group with a ratio ≥1 and the second with a ratio <1. In the second group increases in CBF and CBV after the acetazolamide test were significantly higher in both hemispheres (ipsilateral: +33.0%±8.1% vs. +15.3%±4.4% and +26.3%±6.6% vs. +14.3%±5.1%; contralateral: +26.8%±7.0% vs. +17.6%±5.6% and +20.0%±7.3% vs. +10.0%±3.7%, respectively), cc-TQ was significantly higher only on the ipsilateral side (+37.3%±9.3% vs. +26.6%±8.6%) and the decrease in sas-TQ was less pronounced on the ipsilateral side (−0.7%±1.5% vs. −10.2%±1.5%), in comparison with the first group. The changes in sas-TQ following the acetazolamide test were consistent with the changes in TTP.ConclusionsThe ipsilateral/contralateral cc-TQ ratio following acetazolamide challenge may be used to distinguish patient groups characterized by different haemodynamic parameters. Further research on a larger group of patients is warranted.

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“…[3][4][5] IJV compression and engorgement of the cranial venous system enlarges the brain and increases brain turgor (makes stiffer) through changes in vascular dynamics and cerebrospinal fluid (CSF) absorption. 3,[6][7][8][9][10][11] This reduces relative motion, or slosh, between the brain and the skull and diminishes deformation of the brain. Two previous animal studies have shown a striking reduction in axonal injury through pre-injury application of a customized cervical collar introducing IJV compression.…”

Section: Introductionmentioning

confidence: 99%

Effect of Internal Jugular Vein Compression on Intracranial Hemorrhage in a Porcine Controlled Cortical Impact Model

Sindelar

Bailes

Sherman

et al. 2017

Journal of Neurotrauma

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Internal jugular vein (IJV) compression has been shown to reduce axonal injury in pre-clinical traumatic brain injury (TBI) models and clinical concussion studies. However, this novel approach to prophylactically mitigating TBI through venous congestion raises concerns of increasing the propensity for hemorrhage and hemorrhagic propagation. This study aims to test the safety of IJV compression in a large animal controlled cortical impact (CCI) injury model and the resultant effects on hemorrhage. Twelve swine were randomized to placement of a bilateral IJV compression collar (CCI+collar) or control/no collar (CCI) prior to CCI injury. A histological grading of the extent of hemorrhage, both subarachnoid (SAH) and intraparenchymal (IPH), was conducted in a blinded manner by two neuropathologists. Other various measures of TBI histology were also analyzed including: β-amyloid precursor protein (β-APP) expression, presence of degenerating neurons, extent of cerebral edema, and inflammatory infiltrates. Euthanized 5 h after injury, the CCI+collar animals exhibited a significant reduction in total SAH (p = 0.024-0.026) and IPH scores (p = 0.03-0.05) compared with the CCI animals. There was no statistically significant difference in scoring for the other markers of TBI (β-APP, neuronal degeneration, cerebral edema, or inflammatory infiltration). In conclusion, IJV compression was shown to reduce hemorrhage (SAH and IPH) in the porcine CCI model when applied prior to injury. These results suggest the role of IJV compression for mitigation of not only axonal, but also hemorrhagic injury following TBI.

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Influence of Acute Jugular Vein Compression on the Cerebral Blood Flow Velocity, Pial Artery Pulsation and Width of Subarachnoid Space in Humans

Cited by 40 publications

References 37 publications

Increased inspiratory resistance affects the dynamic relationship between blood pressure changes and subarachnoid space width oscillations

Increased inspiratory resistance affects the dynamic relationship between blood pressure changes and subarachnoid space width oscillations

Near-Infrared Transillumination Back Scattering Sounding—New Method to Assess Brain Microcirculation in Patients with Chronic Carotid Artery Stenosis

Effect of Internal Jugular Vein Compression on Intracranial Hemorrhage in a Porcine Controlled Cortical Impact Model

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