Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2024; 21 (3): 163-272 ➤ Актуальное состояние клинической и инструментальной диагностики церебрального венозного тромбоза и венозного инсульта

Current state of clinical and instrumental diagnosis of cerebral venous thrombosis and venous stroke

Authors: Semenov S.E.1, Shatokhina M.G.2, Voroshilov S.A.3

Company:
1 Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
2 Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
3 Kuzbass Cardiology Center, Kemerovo, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2024-21-3-210-227

UDC: [616.831-005.1:616.14]-07

Link: Clinical Physiology of Blood Circulaiton. 2024; 21 (3): 210-227

Quote as: Semenov S.E., Shatokhina M.G., Voroshilov S.A. Current state of clinical and instrumental diagnosis of cerebral venous thrombosis and venous stroke. Clinical Physiology of Circulation. 2024; 21 (3): 210–227 (in Russ.). DOI: 10.24022/1814-6910-2024-21-3-210-227

Keywords:  cerebral venous thrombosis venous stroke intracranial hypertension perfusion diffusion

Received / Accepted:  15.08.2024 / 06.09.2024

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Abstract

Venous stroke (VI) caused by cerebral venous thrombosis (CVT) is a rare disease and often remains unrecognized or is diagnosed with a significant delay. Clinical suspicion of CVT is confirmed in a small number of cases. This is associated with pathophysiological features, the most important of which is the secondary nature of ischemia in the area of vasogenic edema and moderate congestive hyperperfusion, which was discovered during the study of cellular and tissue perfusion using magnetic resonance (MR) diffusion, single-photon emission computed tomography (SPECT) and computed tomographic (CT) perfusion methods. Secondary hypoxia characterizes the final stage of pathophysiological changes in brain tissue with a violation of the exhaustion of the compensatory mechanism of vasomotor reactions. So far, this is only an empirical assumption that requires detailed study.

Reliable criteria for the diagnosis of CVT and VI are symptoms of a hyperdense vessel and hypodense/pathologically altered ischemic zone in conventional CT/MRI, filling defects and stop contrast in CT and MR venography and contrast- enhanced T1 MR sequences. Among the useful innovations in radiation diagnostics, a method for segmenting the main venous structures of the brain (CVST-Score, 2023) stands out, taking into account partial obstruction for the prognosis of isolated intracranial hypertension.

The classification of venous ischemia using MRI by T. Kawaguchi (2001) requires revision due to the fact that the use of only the criteria of T2WI and gadolinium-enhanced MRI does not correspond to the modern capabilities of the method. It makes sense to use diffusion-weighted images, which have high specificity in differentiating vasogenic and cytotoxic edema.

In cases of small caliber of the affected vessel of cortical localization, suspicions of CVT are often doubtful, and even the use of contrast methods of MRI and CT often does not bring clarity. Probably, further development of technical capabilities of diagnostic equipment will allow to solve this problem.

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About Authors

  • Stanislav E. Semenov, Dr. Med. Sci., Leading Researcher; ORCID
  • Mariya G. Shatokhina, Cand. Med. Sci., Assistant Professor; ORCID
  • Semen A. Voroshilov, Radiologist; ORCID

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