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. 2014 Aug 21:5:317.
doi: 10.3389/fphys.2014.00317. eCollection 2014.

Case report: (Pre)syncopal symptoms associated with a negative internal jugular venous pressure

Niels D Olesen  1 , Johannes J van Lieshout  2 , James P Fisher  3 , Thomas Seifert  1 , Henning B Nielsen  1 , Niels H Secher  1
Affiliations

Case report: (Pre)syncopal symptoms associated with a negative internal jugular venous pressure

Niels D Olesen et al. Front Physiol. .

Abstract

A siphon is suggested to support cerebral blood flow but appears not to be established because internal jugular venous (IJV) pressure is close to zero in upright humans. Thus, in eleven young healthy males, IJV pressure was 9 ± 1 mmHg (mean ± SE) when supine and fell to 3 ± 1 mmHg when seated, and middle cerebral artery mean blood velocity (MCA Vmean; P < 0.007) and the near-infrared spectroscopy-determined frontal lobe oxygenation (ScO2; P = 0.028) also decreased. Another subject, however, developed (pre)syncopal symptoms while seated and his IJV pressure decreased to -17 mmHg. Furthermore, his MCA Vmean decreased and yet within the time of observation ScO2 was not necessarily affected. These findings support the hypothesis that a negative IJV pressure that is a prerequisite for creation of a siphon provokes venous collapse inside the dura, and thereby limits rather than supports CBF.

Keywords: (pre)syncope; cerebrovascular circulation; exercise; internal jugular vein; venous pressure.

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Figures

Figure 1
Figure 1
(A) Mean arterial pressure. (B) Heart rate. (C) Internal jugular venous pressure. (D) Estimated cerebral perfusion pressure during supine rest, rest while seated on the cycle ergometer, and during progressive exercise. • Control subjects (mean ± SE for 11 subjects). ◦ (pre)syncopal subject.
Figure 2
Figure 2
(A) Middle cerebral artery mean blood velocity. (B) Near infrared spectroscopy determined frontal lobe oxygenation (ScO2) during supine rest, rest while seated on the cycle ergometer, and during progressive exercise. • Control subjects (mean ± SE for 11 subjects). ◦ (pre)syncopal subject.
Figure 3
Figure 3
Arterial carbon oxide tension (PaCO2) during supine rest, rest while seated on the cycle ergometer, and during progressive exercise. • Control subjects (mean ± SE for 11 subjects); ◦ (pre)syncopal subject.
Figure 4
Figure 4
Carotid arterial and internal jugular vein cross section for the (pre)syncopal subject when seated on the cycle ergometer. The catheter is visualized in the internal jugular vein.
See this image and copyright information in PMC

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