Postural Changes and Activation Tests



The cerebral venous outflow depends mainly on body position, as demonstrated also by using a mathematical model by Gisolf [1].


Jugular Vertebral Ultrasound Valve Anastomosis 

Supplementary material

Movie 3.1: Breath dynamics of J2 IJV in transverse scan by Color-mode. The wide variations of IJV section size should be signaled during the breath phases (WMV 14393 kb)

Movie 3.2: Dynamic scan of the normal and abnormal J2 CSA variations during normal breath (WMV 6116 kb)

Movie 3.3: Dynamic movement of the J1 IJV valve system in B-mode with Valsalva maneuver. It is notable the closeness of leaflets with a minimal discontinuation (AVI 2138 kb)

Movie 3.4: Dynamic movement of the J1 IJV valve system in Color-mode with Valsalva maneuver. The Valsalva maneuver determines the presence of a regurgitation jet starting from the minimal discontinuation of the leaflets closeness seen in B-mode (movie 3.3) (AVI 2528 kb)

Movie 3.5: J1 IJV in longitudinal scan by Color-mode using the Valsalva maneuver. During the straining phase the valve closes and the blood flow stops (WMV 15026 kb)

Movie 3.6: Longitudinal scan of J2 IJV with breath dynamics at normal rest condition (AVI 1377 kb)

Movie 3.7: Longitudinal scan of J2 IJV in Color-mode with the effects of Valsalva maneuver, with initial physiological rebound of the blood column (AVI 2214 kb)

Movie 3.8: Longitudinal scan of J2 IJV in Color-mode with Valsalva maneuver. It is well evident the corresponding dynamic aspect of the static figure 3.8 (AVI 2165 kb)

Movie 3.9: Dynamic longitudinal scan of J3 IJV in Color-mode with Valsalva maneuver. It is well evident the inversion of flow direction (AVI 2149 kb)

Movie 3.10: Transverse scan of J3 IJV in Color-mode, focusing on the common facial vein accompanying the external carotid artery, while J3 IJV runs with the internal carotid artery. The Valsalva maneuver causes a flow decrease to zero on J3 IJV and an inversion of flow direction (blue color) on the common facial vein (WMV 8854 kb)


  1. 1.
    Gisolf J, van Lieshout JJ, van Heusden K, Pott F, Stok WJ, Karemaker JM (2004) Human cerebral venous outflow pathway depends on posture and central venous pressure. J Physiol 560:317–327PubMedCrossRefGoogle Scholar
  2. 2.
    Cirovic S, Walsh C, Fraser WD, Gulino A (2003) The effect of posture and positive pressure breathing on the hemodynamics of the internal jugular vein. Aviat Space Environ Med 74:125–131PubMedGoogle Scholar
  3. 3.
    Chaynes P, Verdie JC, Moscovici J, Zadeh J, Vaysse P, Becue J (1998) Microsurgical anatomy of the internal vertebral venous plexuses. Surg Radiol Anat 20:47–51PubMedCrossRefGoogle Scholar
  4. 4.
    Toung TJK, Aizawa H, Traystman RJ (2000) Effects of positive end-expiratory pressure ventilation on cerebral venous pressure with head elevation in dogs. J Appl Physiol 88:655–661PubMedGoogle Scholar
  5. 5.
    Batson OV (1957) The vertebral vein system. AJR Am J Roentgenol 78:195–212Google Scholar
  6. 6.
    Cooper ERA (1960) The vertebral venous plexus. Acta Anat 42:333–351PubMedCrossRefGoogle Scholar
  7. 7.
    Schreiber SJ, Lurtzing F, Gotze R et al (2003) Extra-jugular pathways of human cerebral venous blood drainage assessed by duplex ultrasound. J Appl Physiol 94:1802–1805PubMedGoogle Scholar
  8. 8.
    Doepp F, Schreiber SJ, von Munster T et al (2004) How does the blood leave the brain? A systematic ultrasound analysis of cerebral venous drainage patterns. Neuroradiology 46:565–570PubMedCrossRefGoogle Scholar
  9. 9.
    Dawson EA, Secher NH, Dalsgaard MK, Ogoh S, Yoshiga CC, Gonzalez-Alonso J, Steensberg A, Raven PB (2004) Standing up to the challenge of standing: a siphon does not support cerebral blood flow in humans. Am J Physiol Regul Integr Comp Physiol 287:R911–R914PubMedCrossRefGoogle Scholar
  10. 10.
    Valdueza JM, von Munster T, Hoffman O et al (2000) Postural dependency of the cerebral venous outflow. Lancet 355:200–201PubMedCrossRefGoogle Scholar
  11. 11.
    Schreiber SJ, Lambert UK, Doepp F, Valdueza JM (2002) Effects of prolonged head down tilt on internal jugular vein cross-sectional area. Br J Anaesth 89:769–771PubMedCrossRefGoogle Scholar
  12. 12.
    Alperin N, Lee SH, Sivaramakrishnan A, Hushek SG (2005) Quantifying the effect of posture on intracranial physiology in humans by MRI flow studies. J Magn Reson Imaging 22:591–596PubMedCrossRefGoogle Scholar
  13. 13.
    Alperin N, Lee SH, Mazda M, Hushek SG, Roitberg B, Goddwin J, Lichtor T (2005) Evidence for the importance of extracranial venous flow in patients with idiopathic intracranial hypertension (IIH). Acta Neurochir Suppl 95:129–132PubMedCrossRefGoogle Scholar
  14. 14.
    Schrauben et al (2012) Respiratory effects on phase contrast imaging of the jugular vein. J Cardiovasc Magnetic Resonance 14(Suppl 1):W4Google Scholar
  15. 15.
    LEE SC, HAN SS, SHIN SY, LIM YJ, KIM JT, KIM YH (2012) Relationship between positive end-expiratory pressure and internal jugular vein cross-sectional area, Acta Anesthesiologica Scandinavica Acta Anaesthesiol Scand, 56(7):840–845Google Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  1. 1.Stroke Unit, Neurology Unit, Dept. of Neuromotor PhysiologyArcispedale Santa Maria Nuova IRCCSReggio EmiliaItaly
  2. 2.CIDIMUTorinoItaly

Personalised recommendations