Diagnostic methods, calculation parameters and gradations of extrinsic compression stenosis of the internal jugular veins

Background. Growing interest in external compressive stenosis of the internal jugular veins (IJV) stems from its proposed role in the pathogenesis of intracranial hypertension and cerebral venous dysfunction. However, the literature lacks consensus on terminology, diagnostic criteria, stenosis grading systems, and threshold values, hampering inter-study comparability and evidence-based clinical guidance.
Objective. To systematize available data on diagnostic methods, calculated parameters, and grading systems for external compressive IJV stenosis, and to evaluate stenosis thresholds associated with intracranial venous congestion and clinical manifestations of cerebral venous dysfunction.
Materials and Methods. A narrative review of Russian- and English-language literature published between 1965 and 2025 was conducted using Medline/PubMed and the Russian Science Citation Index (RSCI/eLibrary). Search terms included: venous outflow, external stenosis, internal jugular vein, cerebral venous dystonia/dysfunction/congestion/stasis, venous encephalopathy, and intracranial hypertension, as well as their Russian-language equivalents.
Results. A stenosis threshold of 70–80% in one IJV was identified as the critical value for the development of intracranial venous congestion with clinical manifestations of cerebral venous dysfunction and venous encephalopathy. The venous-arterial balance (VAB) calculator was identified as a promising supplementary diagnostic tool: a total VAB below 40% indicates high probability of intracranial venous congestion, while values in the 40–59% range represent a zone of uncertainty, the clinical outcome of which depends on the degree of compensatory remodeling of cervical venous collaterals. The non-invasive combination of duplex ultrasound scanning and non-contrast magnetic resonance venography is recommended as the preferred first-line diagnostic approach.
Conclusion. External compressive IJV stenosis is a clinically significant yet insufficiently standardized entity. Establishing unified diagnostic criteria, stenosis grading systems, and venous balance parameters is essential for achieving inter-study comparability and building an evidence base for surgical correction of impaired cerebral venous drainage.

1. Zhou D., Meng R., Zhang X., et al. Intracranial hypertension induced by internal jugular vein stenosis can be resolved by stenting // Eur J Neurol. 2018. Vol. 25 (2). P. 365-e13. doi: 10.1111/ene.13512.

2. Semenov S.E., Bondarchuk D.V., Kokov A.N., Shatokhina M.G. Indicators of non-thrombotic disorders of cerebral venous drainage through extracranial veins. Siberian Scientific Medical Journal, 2024. Vol. 44, No. 1. P. 76-87 (in Russ.). doi: 10.18699/SSMJ20240108.

3. Semenov S.E., Shatokhina M.G., Bondarchuk D.V., Moldavskaya I.V. On the problem of diagnostics of initial manifestations of cerebral venous circulation insufficiency // Clinical physiology of blood circulation. 2022. Vol. 19, No. 3. P. 266-279 (in Russ.). doi: 10.24022/1814-6910-2022 1.

4. Korneeva N.V., Lovrikova M.A., Zhmerenetsky K.V. Methodology for assessing venous outflow during ultrasound scanning of the brachiocephalic vessels: state of the problem // Cardiovascular Therapy and Prevention. 2024. Vol. 23, No. 6. P. 3913. (in Russ.). doi: 10.15829/1728-8800-2024-3913.

5. Berdichevsky M.Ya. Venous cerebrovascular pathology. Moscow: Medicine, 1989. 224 p. (in Russ.).

6. Babenkov N.V. Disorders of venous circulation of the brain: pathogenesis, clinical picture, causes, diagnostics (review) // Journal of Neuropathology and Psychiatry n.a. S.S. Korsakov. 1984. Vol. 84, No. 2. P. 281-288. (in Russ.).

7. Wayne B.N., Spektor S.M. Betolepsy in patients with multiple lesions of large cerebral vessels // Journal of Neuropathology and Psychiatry named after S.S. Korsakov. 1991. Vol. 91, No. 6. P. 19-22. (in Russ.).

8. Chukanova E.I., Mamaeva H.I., Chukanova A.S. Treatment of chronic cerebral venous insufficiency: study of the effect of L-lysine aescinate // Journal of Neurology and Psychiatry named after S.S. Korsakov. 2016. Vol. 116, No. 7. P. 37-41. (in Russ.) doi: 10.17116/jnevro20161167137-41.

9. Skoromets A.A. Handbook of a neurologist / edited by A.A. Skoromets. Moscow: MEDpress-inform, 2008. P. 74-76. (in Russ.).

10. Verulashvili I., Beraya M., Kortushvili M. Features of cerebral venous hemodynamics in chronic cerebral circulatory disorders // Effective pharmacotherapy. 2018. No. 24. P. 88-92. (in Russ.).

11. Schmidt E.V. Vascular diseases of the nervous system. Moscow: Medicine, 1975. PP. 11-100, 437-451. (in Russ.).

12. Nazarova Zh.A., Bakhardinov M.M. Features of venous cerebral hemodynamics in acute cerebrovascular accidents // Bulletin of Emergency Medicine. 2019. Vol. 12, No. 6. P. 35-41 (in Russ.).

13. Alekseev V.V., Shekhter A.I., Skorobogatykh K.V., Shashkova E.V. Headaches in intracranial venous dysfunction // Pain. 2008. Vol. 20, No. 3. P. 15-21. (in Russ.).

14. Semenov S.E., Bondarchuk D.V., Malkov I.N., Shatokhina M.G. Remodeling of the neck veins and venous-arterial balance in external compression stenosis and hypoplasia of the internal jugular veins // Angiology and vascular surgery. Journal named after Academician A.V. Pokrovsky. 2024. Vol. 30, No. 4. Pp. 18-31. doi: 10.33029/1027-6661-2024-30-4-18-31 (in Russ.). doi: 10.33029/1027-6661-2024-30-4-18-31.

15. Semenov S.E., Bondarchuk D.V., Malkov I.N., Shatokhina M.G. Remodeling of extracranial veins and venous-arterial imbalance in external stenosis and hypoplasia of the internal jugular veins // Siberian Scientific Medical Journal. 2024. Vol. 44, No. 1. P. 61-75. (in Russ.). doi: 10.18699/SSMJ20240107.

16. Semenov S.E., Bondarchuk D.V., Malkov I.N., Shatokhina M.G. Ultrasound and magnetic resonance semiotics of compression and hypoplasia of the internal jugular veins // Complex problems of cardiovascular diseases. 2023. Vol. 12, No. 1. P. 72-83. (in Russ.). doi: 10.17802/2306-1278-2023-12-1-72-83.

17. Bateman A.R., Bateman G.A., Barber T. The relationship between cerebral blood flow and venous sinus pressure: can hyperemia induce idiopathic intracranial hypertension? // Fluids Barriers CNS. 2021. Vol. 18 (1). P. 5. doi: 10.1186/s12987-021-00239-2.

18. Fargen K.M., Midtlien J.P., Margraf C. et al. Dynamic internal jugular vein venography: a descriptive study in 89 patients with suspected cerebral venous outflow disorders // J Neurointerv Surg. 2025. Jan 25. P. jnis-2024-021734. doi: 10.1136/jnis-2024-021734.

19. Fargen K.M., Midtlien J.P., Margraf C.R., Hui F.K. Idiopathic intracranial hypertension pathogenesis: The jugular hypothesis // Interventional Neuroradiology. 2024. Aug 8. P. 15910199241270660. doi: 10.1177/15910199241270660.

20. Shumilina M.V. Ultrasound assessment of the significance of vascular pathology in headaches of "unclear origin": lecture // Angiology and vascular surgery. Journal n.a. Academician A.V. Pokrovsky. 2022. Vol. 28 (3). P. 15-22 (in Russ.). doi: https://doi.org/10.33029/1027-6661-2022-28-3-15-22.

21. Shumilina M.V. Ultrasound examinations for headaches in patients with cardiovascular pathology: a teaching guide. Moscow, publishing house of the Federal State Budgetary Institution A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, 2022. 78 p. (in Russ.).

22. Kulikov V.P. Fundamentals of ultrasound examination of vessels. Moscow: Publishing house Vidar-M, 2015. 392 p., ill. ISBN 978-5-88429-215-4 (in Russ.).

23. Ahn S.S., Miller T.J., Chen S.W., Chen J.F. Internal jugular vein stenosis is common in patients presenting with neurogenic thoracic outlet syndrome // Ann Vasc Surg. 2014. Vol. 28. P. 946‐950.

24. Shumilina M.V., Shchanitsyn I.N., Kolesnik D.I. New forms of vascular pathology: styloid-carotid, sublingual-carotid, thyroid-carotid and styloid-jugular syndromes (Eagle's vascular syndrome) // Complex problems of cardiovascular diseases. 2020. Vol. 3. P. 96-106. (in Russ.).

25. Ding J.Y., Zhou D., Pan L.Q., et al. Cervical spondylotic internal jugular venous compression syndrome // CNS Neurosci Ther. 2020. Vol. 26 (1). P. 47-54. doi: 10.1111/cns.13148.

26. Li M., Sun Y., Chan C.C., et al. Internal jugular vein stenosis associated with elongated styloid process: five case reports and literature review // BMC Neurol. 2019. Vol. 19 (1). P. 112. doi: 10.1186/s12883-019-1344-0.

27. Rashid A., Iqrar S.A., Rashid A., Simka M. Results of Numerical Modeling of Blood Flow in the Internal Jugular Vein Exhibiting Different Types of Strictures // Diagnostics (Basel). 2022. Vol. 12 (11). P. 2862. doi: 10.3390/diagnostics12112862.

28. Dashti S.R., Nakaji P., Hu Y. C., et al. Styloidogenic jugular venous compression syndrome: diagnosis and treatment: case report // Neurosurgery. 2012. Vol. 70. P. E795‐E799.

29. Tadjer J., Béjot Y. Vascular variant of Eagle syndrome: a review // Front Neurol. 2024. Vol. 15. P. 1463275. doi: 10.3389/fneur.2024.1463275.

30. Oushy S., Wald J.T., Janus J., et al. Dynamic Internal Jugular Vein Compression by Hypertrophic Hyoid Bone: Management and Outcomes // Cureus. 2020. Vol. 12 (3). P. e7445. doi: 10.7759/cureus.7445.

31. Clausen T.M., Fargen K.M., Primiani C. T., et al. Post-acute sequelae of COVID infection and cerebral venous outflow disorders: Overlapping symptoms and mechanisms? // Interv Neuroradiol. 2024. Sep 2. P. 15910199241273946. doi: 10.1177/15910199241273946.

32. İlhan Z., Açıkgözoğlu S., Demir O. Associations Between Doppler Internal Jugular Vein Blood Flow and Transverse Sinus Stasis Detected by Magnetic Resonance Imaging // J Ultrasound Med. 2021. Vol. 40 (8). P. 1591-1601. doi: 10.1002/jum.15541.

33. Shumilina M.V., Spiridonov A.A., Buziashvili Yu.I. et al. Imbalance of venous cerebral circulation in the genesis of encephalopathy in patients with cardiovascular diseases // Annals of Surgery. 2001. No. 4. P. 62-67. (in Russ.).

34. Nosenko E.M., Nosenko N.S., Dadova L.V. Duplex scanning of extracranial parts of the brachiocephalic arteries and veins: a tutorial. Moscow: Publishing house Vidar-M, 2022. 398 p., ill. ISBN 978-5-88429-276-5. (in Russ.).

35. Shumilina M.V., Kolesnik D.I. Effect of orthostatic test (or verticalization) on blood flow in the internal jugular and vertebral veins // Complex problems of cardiovascular diseases. 2023. Vol. 12 (1). P. 39-48. doi: 10.17802/2306-1278-2023-12-1-39-48. (in Russ.).

36. Han K., Chao A.C., Chang F.C., et al. Obstruction of Venous Drainage Linked to Transient Global Amnesia // PLoS One. 2015. Vol. 10 (7). P. e0132893. doi: 10.1371/journal.pone.0132893.

37. Bateman G.A., Yap S.L., Subramanian G.M., Bateman A.R. The incidence of significant venous sinus stenosis and cerebral hyperemia in childhood hydrocephalus: prognostic value with regards to differentiating active from compensated disease // Fluids Barriers CNS. 2020. Vol. 17 (1). P. 33. doi: 10.1186/s12987-020-00194-4.

38. Manupipatpong S., Primiani C.T., Fargen K.M., et al. Jugular venous narrowing and spontaneous spinal cerebrospinal fluid leaks: A case-control study exploring association and proposed mechanism // Interv Neuroradiol. 2024. Vol. 30 (6). P. 812-818. doi: 10.1177/15910199241287417.

39. Abdalkader M, Miller MI, Klein P, et al. Differential Assessment of Internal Jugular Vein Stenosis in Patients Undergoing CT and MRI with Contrast // Tomography. 2024. Vol. 10(2). P. 266-276. doi:10.3390/tomography10020021

40. Bateman G.A., Stevens S.A., Stimpson J. A mathematical model of idiopathic intracranial hypertension incorporating increased arterial inflow and variable venous outflow collapsibility // J Neurosurg. 2009. Vol. 110 (3). P. 446-456. doi: 10.3171/2008.6.17609.

41. Smolock E., Berk C.B. Ed. Hill J.A., Olson E.N. Vascular Smooth Muscle Cell Remodeling in Atherosclerosis and Restenosis. Chapter 98 // Muscle, Academic Press, 2012. P. 1301-1309. ISBN 9780123815101. doi: 10.1016/B978-0-12-381510-1.00098-3. URL: https://www.sciencedirect.com/science/article/pii/B9780123815101000983

42. Hutchison S.D., Holmes K.K. Ultrasound diagnostics in angiology and vascular surgery; trans. from English; edited by Kiriyenko A.I., Churikov D.A. M.: GEOTAR-Media, 2023. 400 p. (in Russ.).

43. Doepp F., Schreiber S.J., von Münster T., et al. How does the blood leave the brain? A systematic ultrasound analysis of cerebral venous drainage patterns // Neuroradiology. 2004. Vol. 46 (7). P. 565-570. doi: 10.1007/s00234-004-1213-3.

44. Tanoue S., Kiyosue H., Sagara Y., et al. Venous structures at the craniocervical junction: anatomical variations evaluated by multidetector row CT// Br J Radiol. 2010. Vol. 83. P. 831‐840.

45. Schaller B. Physiology of cerebral venous blood flow: from experimental data in animals to normal function in humans // Brain Res Brain Res Rev. 2004. Vol. 46. P. 243-260. doi: 10.1016/j.brainresrev.2004.04.005.

46. Bekov D.B. Atlas of the venous system of the human brain. Moscow: Medicine, 1965. 358 p. (in Russ.).

47. Thibault P., Lewis W., Niblett S. Objective duplex ultrasound evaluation of the extracranial circulation in multiple sclerosis patients undergoing venoplasty of internal jugular vein stenoses: a pilot study // Phlebology. 2015. Vol. 30 (2). P. 98-104. doi: 10.1177/0268355513515473.

48. Dolic K., Siddiqui A.H., Karmon Y., et al. The role of noninvasive and invasive diagnostic imaging techniques for detection of extracranial venous system anomalies and developmental variants // BMC Med. 2013. Vol. 11. P. 155. doi: 10.1186/1741-7015-11-155.

49. Gadda G., Taibi A., Sisini F., et al. Validation of a hemodynamic model for the study of the cerebral venous outflow system using MR imaging and echo-color doppler data // AJNR Am J Neuroradiol. 2016. Vol. 37. P. 2100-2109. doi: 10.3174/ajnr.A4860.

50. Marr K., Jakimovski D., Mancini M., et al. Jugular Venous Flow Quantification Using Doppler Sonography // Ultrasound Med Biol. 2018. Vol. 44 (8). P. 1762-1769. doi: 10.1016/j.ultrasmedbio.2018.04.010.

51. Zivadinov R, Galeotti R, Hojnacki D, et al. Value of MR venography for detection of internal jugular vein anomalies in multiple sclerosis: a pilot longitudinal study // AJNR Am J Neuroradiol. 2011. Vol. 32 (5) P. 938-946. doi:10.3174/ajnr.A2386

52. Wang Z., Ding J., Bai C., et al. Clinical Classification and Collateral Circulation in Chronic Cerebrospinal Venous Insufficiency // Front. Neurol. 2020. Vol. 11. P. 913. doi: 10.3389/fneur.2020.00913.

53. Zamboni P., Menegatti E., Cittanti C., et al. Fixing the jugular flow reduces ventricle volume and improves brain perfusion // J Vasc Surg Venous Lymphat Disord. 2016. Vol. 4 (4). P. 434-445. doi: 10.1016/j.jvsv.2016.06.006.

54. Kosugi K., Yamada Y., Yamada M., et al. Posture-induced changes in the vessels of the head and neck: evaluation using conventional supine CT and upright CT // Sci Rep. 2020. Vol. 10 (1). P. 16623. doi: 10.1038/s41598-020-73658-0.

55. Mohammadyari P., Gadda G., Taibi A. Modelling physiology of haemodynamic adaptation in short-term microgravity exposure and orthostatic stress on Earth // Sci Rep. 2021. Vol. 11 (1). P. 4672. doi: 10.1038/s41598-021-84197-7.

56. Bukhovets I.L., Maksimova A.S., Kuznetsov M.S., et al. Venous outflow through the internal jugular veins with varying degrees of stenosis of the internal carotid arteries according to ultrasound data // Angiology and vascular surgery. Journal n.a. Academician A.V. Pokrovsky. 2023. Vol. 29, No. 3. P. 15-23. (in Russ.). doi: https://doi.org/10.33029/1027-6661-2023-29-3-15-23.

57. Semenov S.E., Bondarchuk D.V., Shatokhina M.G. Certificate of state registration of computer program RU 2025617702 "Program for calculating cerebral venous-arterial balance (VAB) of blood flow at the extracranial level", 03/27/2025. Application No. 2025616203 dated 03/20/2025. (in Russ.).

58. Savelyeva L.A., Tulupov A.A. Features of venous outflow from the brain, according to magnetic resonance angiography // Bulletin of NSU. Series: Biology, clinical medicine. 2009. Vol. 7, No. 1. P. 36-40. (in Russ.).

59. Torres C., Hogan M., Patro S., et al. Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant? // Eur Radiol. 2017. Vol. 27 (1). P. 239-246. doi: 10.1007/s00330-016-4314 6.

60. Jayaraman M.V., Boxerman J.L., Davis L.M., et al. Incidence of extrinsic compression of the internal jugular vein in unselected patients undergoing CT angiography // AJNR Am J Neuroradiol. 2012. Vol. 33 (7). P. 1247-1250. doi: 10.3174/ajnr.A2953.