Collapsed Jugular Vein and abnormal cerebral blood flow changes in patients of Panic Disorder

Yu Chien Tsao, Chih Ping Chung, Hung Yi Hsu, Chun Yu Cheng, A. Ching Chao, Wen Yung Sheng, Han Hwa Hu, Chen Jee Hong, Jaw Ching Wu

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Objective: Panic disorder (PD) is characterized by panic attacks accompanied with respiratory symptoms. Internal jugular vein (IJV) alters its hemodynamics in response to respiration and which might cause cerebral blood flow (CBF) changes. In the present study, we compared (1) respiratory-related IJV hemodynamics and (2) CBF changes during Valsalva maneuver (VM) between PD and normal subjects. Methods: 42 PD patients and age/gender-matched controls (14 men; 52.3±11.4 years) were recruited. Duplex ultrasonography measured time-averaged mean velocity (TAMV) and lumen in IJV at baseline and deep inspiration. Lumen area <0.10cm2 at deep inspiration was defined as IJV collapse. CBF changes during VM were recorded by transcranial Doppler (TCD). Results: Compared with normal group, PD patients had significantly higher frequency of IJV collapse at deep inspiration (Left: 40.0% vs. 7.0%, p=0.0003, Right: 17.0% vs. 0%, p=0.0119). IJV collapse was associated with symptoms of respiratory subtype in our PD patients. PD group also had smaller lumen (Left: 0.53±0.29 vs. 0.55±0.26cm2, p=0.8296, Right: 0.63±0.36 vs. 0.93±0.45cm2, p=0.0014) and slower TAMV of IJV at baseline (Left: 11.8±8.43 vs. 20.6±16.5cm/s, p=0.0003, Right: 15.9±9.19 vs. 24.1±15.7cm/s, p=0.0062). PD patients with inspiration-induced IJV collapse had more decreased CBF during VM compared with the other PD patients and normal individuals respectively. Interpretation: We are the first to show that PD have less IJV flow at baseline and more frequent collapse at deep inspiration. Inspiration-induced IJV collapsed was associated with CBF decrement during VM in PD patients. These results suggest that venous drainage impairment might play a role in the pathophysiology of PD by influencing CBF.

Original languageEnglish
Pages (from-to)155-160
Number of pages6
JournalJournal of Psychiatric Research
Publication statusPublished - Nov 1 2014
Externally publishedYes


  • Cerebral blood flow
  • Jugular vein
  • Panic disorder

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry


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