Venous Bruit, Jugular Bulb, and Increased Intracranial Pressure

To the Editor.  —Adler and Ropper have noted an important association between cranial venous bruit, and enlarged, high-jugular bulb.¹ In our previous reports of venous bruit with increased intracranial pressure, we noted that increased jugular flow occurred on the side of the bruit.^2,3 However, we did not report the association of the anatomical variant (ie, enlarged, high-jugular bulb). In retrospect, we found that two of our patients, in whom tomograms, and/or jugular venograms were available, did have enlarged jugular bulbs on the side of the bruits.The enlarged, displaced jugular bulb helps explain the unilateral location of the self-audible bruit. It may even contribute to the objective bruits we described, by producing turbulence. However, it alone cannot explain the low incidence of the bruit in the general population, considering the relative frequency of this anatomical variant, and it does not explain the direct correlation of the bruit with