Clinical and instrumental indicators of intracranial venous stasis and secondary ischemia in cerebral sinus thrombosis. A review

Abstract

The purpose of the narrative review is to search for confirmation or controversy of the hypothesis according to which venous ischemia developing in cerebral venous sinustrombosis is secondary as a result of mechanical narrowing of arterioles in the area of vasogenic edema. This review discusses the issues of multimodal radiological diagnosis of a rare disease of a non-hemorrhagic ischemic venous stroke based on expert opinion, current recommendations and our experience. As a result of the review no contradictions to this hypothesis have been found, and the most characteristic symptoms of CVT, secondary ischemia, intracranial venous congestion can be identified in the order of their probable clinical manifestation from patient complaints to the results of instrumental studies: headache, subacute development and course of the disease, papilledema optic disc, increase of central venous pressure, hypodensity of the ischemic foci and hyperdensity signs of sinus on CT, earlier development of vasogenic edema on diffusion MRI, symptoms of stop-contrast and filling defect thrombosed sinuses on contrast enhancement CTA or MRA, dilatation of venous regional collaterals, moderate hyperperfusion on CT-or MR-perfusion, elevated maximum blood flow velocity Rosenthal veins; Galen's vein and rectus sinus, decreased cerebrovascular reactivity index, increased peripheral resistance index on Transcranial Doppler, clot visualization on brachiocephalic veins ultrasound duplex scanning, decreasing of brachiocephalic vessels ultrasound index of arteriovenous ratio.