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Background. A necktie may elevate intracranial pressure through compression of venous return.  We hypothesised that a tight necktie would deleteriously alter cerebrovascular reactivity. Materials and Methods. A necktie was simulated using bespoke apparatus comprising pneumatic inner-tube with aneroid pressure-gauge.  Using a randomised crossover design, cerebrovascular reactivity was measured with the “pseudo-tie” worn inflated or deflated for 5 minutes (simulating tight/loose necktie resp.).  Reactivity was calculated using breath hold index (BHI) and paired “t” testing used for comparative analysis. Results. We enrolled 40 healthy male volunteers.  There was a reduction in cerebrovascular reactivity of 0.23 units with “tight” pseudotie (BHI loose 1.44 (SD 0.48); BHI tight 1.21 (SD 0.38) P<.001). Conclusion. Impairment in cerebrovascular reactivity was found with inflated pseudo-tie.  However, mean BHI is still within a range of considered normal.  The situation may differ in patients with vascular risk factors, and confirmatory work is recommended

Neckties and Cerebrovascular Reactivity in Young Healthy Males: A Pilot Randomised Crossover Trial