Задачей обзорного исследования стал поиск наиболее подходящего определения и термина, выделен симптомокомплекс минимально выраженных клинических проявлений внутричерепной гипертензии при верифицируемых радиологическими способами гемодинамически незначимых или малозначимых, но очевидных нарушениях оттока венозной крови из полости черепа по дуральным венозным синусам головного мозга, внутренним яремным и безымянным венам. В результате заочного обсуждения множества терминов и классификаций клинических проявлений такого рода состояний предлагается для использования компромиссный термин «минимальная церебральная венозная недостаточность» (minimal cerebral venous insufficiency), который включает не отражение стадии процесса, а лишь его патофизиологическую составляющую и легкую степень выраженности. Независимо от причин (интракраниальных или экстракраниальных, внутрипросветного тромбоза или наружного стеноза/компрессии), ведущей и нередко единственной жалобой больного может быть «утренняя» головная боль с оценкой от 3 до 5 баллов по визуально-аналоговой шкале интенсивности головной боли или головная боль, возникающая/усиливающаяся при принятии пациентом горизонтального положения. Могут отмечаться симптомы «высокой подушки» и «песка в глазах», пастозность лица и век в утренние часы, «машинный» шум в голове, проявления астенического синдрома, легкие когнитивные расстройства в виде плохого усвоения новых знаний и снижения концентрации внимания, проявления астенического (астеновегетативного) синдрома. Лишь косвенные признаки венозного застоя позволяет обнаружить нативная компьютерная томография (КТ). Магнитно-резонансная томография при условии использования последовательностей Т2* и SWI в совокупности с МР-венографией считается «золотым стандартом» визуализации аномалий и патологии церебральных венозных сосудов. В сомнительных случаях верифицирующей методикой становится контрастная КТ-ангиография. Повышение скорости кровотока по прямому синусу и вене Галена, псевдопульсация являются наиболее частыми допплерографическими паттернами церебральной венозной недостаточности. Надежна прямая визуализация стеноза и тромбов внутренних яремных вен при УЗИ; в качестве нового способа диагностики церебрального венозного застоя может рассматриваться ультразвуковой показатель артериовенозного соотношения при снижении до уровня 40–50%. Клинические проявления «минимальной церебральной венозной недостаточности» коррелируют со стенозированием внутренних яремных вен в пределах от более 50% до менее 70%. HTML

A review of current neurological and radiological algorithms for the diagnosis of venous stroke recommended in the national and international medical literature has been presented. All existing methods and techniques in modern radiology as well as the semiology of venous stroke associated with their application are critically reviewed. The optimal sequence, timing, and reasons of applying a concrete technique from the standpoint of its diagnostic accuracy and effectiveness are discussed based on the recent national and international guidelines. Venous stroke in cerebral venous sinus thrombosis is a rare pathological condition with uncertain diagnostic algorithm to ensure prompt treatment by neurologists and radiologists. All the methods are not obligatory in the workup of acute stroke, except computed tomography (CT) and transcranial Doppler. Researchers and clinicians are commonly guided by their own experiences. Therefore, the diagnosis of venous stroke is an unstable process resulting in its underestimation in the general stroke population. The optimal use of neuroimaging methods within the existing standards of care for patients with stroke, determination of the necessary and sufficient set of diagnostic procedures is an organizational and methodical problem. In addition, there is no complete description of venous ischemic stroke patterns in the medical literature. The article reviews existing evidence-based data on the diagnostic algorithms for venous stroke and discusses the probability of detecting radiologic symptoms based on the diagnostic accuracy and effectiveness of such methods as conventional CT and magnetic resonance imaging (MRI), CT and MR angiography, CT and MR perfusion, transcranial Doppler (TCD) and ultrasound of the brachiocephalic arteriess stated in the national and international guidelines, as well as our own experience. Limitations of their use and options to overcome major drawbacks including the introduction of teleradiology are considered.

Venous stroke in cerebral venous sinus thrombosis is a rare pathological condition with uncertain diagnostic algorithm to ensure prompt treatment by neurologists and radiologists. All the methods are not obligatory in the workup of acute stroke, except computed tomography (CT) and transcranial Doppler. Researchers and clinicians are commonly guided by their own experiences. Therefore, the diagnosis of venous stroke is an unstable process resulting in its underestimation in the general stroke population. The optimal use of neuroimaging methods within the existing standards of care for patients with stroke, determination of the necessary and sufficient set of diagnostic procedures is an organizational and methodical problem. In addition, there is no complete description of venous ischemic stroke patterns in the medical literature. The article reviews existing evidence-based data on the diagnostic algorithms for venous stroke and discusses the probability of detecting radiologic symptoms based on the diagnostic accuracy and effectiveness of such methods as conventional CT and magnetic resonance imaging (MRI), CT and MR angiography, CT and MR perfusion, transcranial Doppler (TCD) and ultrasound of the brachiocephalic arteries stated in the national and international guidelines, as well as our own experience. Limitations of their use and options to overcome major drawbacks including the introduction of teleradiology are considered.

Venous stroke being “relatively unknown cerebrovascular disease” occurs in 0.55% of all strokes. Specific diagnostic concerns to venous stroke and the expansion of the volume of radiologic examinations from routinely used non-contrast CT to angiographic and perfusion CT- and MRI, diffusion MRI allowed us to increase the number of diagnosed and verified venous ischemic stroke from 0.4% of all strokes treated in our center to 2.4%, resulting in a 6-fold increase within the 5-year period. Symptoms of cerebral venous sinus thrombosis depend on the size and the growth rate of thrombus. In addition, focal neurological symptoms are diverse and largely dependent on thrombus localization and safety of collateral blood flow, as well as patients’ age and severity of cerebral edema. Cerebral symptoms are nonspecific and may occur in varying degrees of severity related to the localization of the pathological process. The routinely used assessment scales such as the National Institutes of Health Stroke Scale (NIHSS), Bartel Index, Rankin Scale do not reliably identify this type of acute ischemic stroke. The leading symptom is headache with the mean visual analogue scale of 7.3±1.6. The tendency towards a less pronounced neurologic deficit at admission and mild disability status at discharge have been found among patients with venous stroke. The clinical course of venous stroke mostly demonstrated a tendency towards rapid regression of focal symptomatology and neurological deficit in comparison with arterial ischemic stroke.

Venous stroke being “relatively unknown cerebrovascular disease” occurs in 0.55% of all strokes. Specific diagnostic concerns to venous stroke and the expansion of the volume of radiologic examinations from routinely used non-contrast CT to angiographic and perfusion CT- and MRI, diffusion MRI allowed us to increase the number of diagnosed and verified venous ischemic stroke from 0.4% of all strokes treated in our center to 2.4%, resulting in a 6-fold increase within the 5-year period. Symptoms of cerebral venous sinus thrombosis depend on the size and the growth rate of thrombus. In addition, focal neurological symptoms are diverse and largely dependent on thrombus localization and safety of collateral blood flow, as well as patients’ age and severity of cerebral edema. Cerebral symptoms are nonspecific and may occur in varying degrees of severity related to the localization of the pathological process. The routinely used assessment scales such as the National Institutes of Health Stroke Scale (NIHSS), Bartel Index, Rankin Scale do not reliably identify this type of acute ischemic stroke. The leading symptom is headache with the mean visual analogue scale of 7.3±1.6. The tendency towards a less pronounced neurologic deficit at admission and mild disability status at discharge have been found among patients with venous stroke. The clinical course of venous stroke mostly demonstrated a tendency towards rapid regression of focal symptomatology and neurological deficit in comparison with arterial ischemic stroke.

A review of current neurological and radiological algorithms for the diagnosis of venous stroke recommended in the national and international medical literature has been presented. All existing methods and techniques in modern radiology as well as the semiology of venous stroke associated with their application are critically reviewed. The optimal sequence, timing, and reasons of applying a concrete technique from the standpoint of its diagnostic accuracy and effectiveness are discussed based on the recent national and international guidelines. Venous stroke in cerebral venous sinus thrombosis is a rare pathological condition with uncertain diagnostic algorithm to ensure prompt treatment by neurologists and radiologists. All the methods are not obligatory in the workup of acute stroke, except computed tomography (CT) and transcranial Doppler. Researchers and clinicians are commonly guided by their own experiences. Therefore, the diagnosis of venous stroke is an unstable process resulting in its underestimation in the general stroke population. The optimal use of neuroimaging methods within the existing standards of care for patients with stroke, determination of the necessary and sufficient set of diagnostic procedures is an organizational and methodical problem. In addition, there is no complete description of venous ischemic stroke patterns in the medical literature. The article reviews existing evidence-based data on the diagnostic algorithms for venous stroke and discusses the probability of detecting radiologic symptoms based on the diagnostic accuracy and effectiveness of such methods as conventional CT and magnetic resonance imaging (MRI), CT and MR angiography, CT and MR perfusion, transcranial Doppler (TCD) and ultrasound of the brachiocephalic arteriess stated in the national and international guidelines, as well as our own experience. Limitations of their use and options to overcome major drawbacks including the introduction of teleradiology are considered.

The clinical case reports the first experience of thrombus extraction in a young patient with ischemic stroke and severe concomitant pathology. The 33-year old patient was admitted to the hospital with stroke 4 hours after its onset. The occlusion of the distal Ml segment of the left middle cerebral artery was documented with MSCT. A satisfactory clinical result of the thrombus extraction in ischemic stroke was achieved, despite the changed treatment strategy commonly used for from this pathology (thrombolytic therapy and thrombus extraction). The refusal of thrombolytic therapy was associated with the presence of destructive pulmonary tuberculosis and a high risk of pulmonary hemorrhage. Successful thrombus extraction from the M1 segment of the left middle cerebral artery segment with the final blood flow in the left internal carotid artery at the level of TICI III was performed. At discharge the patient demonstrated improved neurological status with the modified Rankin score of 3.

The cerebral venous congestion is the primary factor in damaging the brain with cerebral venous thrombosis. Ischemia in stroke associated with cerebral venous sinusthrombosis (CVST) is secondary, developing as a result of externally induced constriction of the blood vessels feeding the area of stasis in vasogenic edema, which leads to necrosis is less likely than with arterial ischemic stroke. Stroke associating CVST more often accompanied by hemorrhagic transformation than atherothrombotic. Venous congestion is detected in cardioembolic stroke in the perifocal zone of the ischemic focus, and probably plays a role in the courses and outcomes of stroke, contributing to the development of vasogenic edema and early secondary hemorrhage. Identify venous stasis in principle possible using the technique of determining the ultrasound index arteriovenous ratio and sighting in the ischemic focus and perifocal zone as hyperperfusion using perfusion techniques MSCT or MRI of the brain.

Purpose. The study was aimed at detecting the signs of focal and perifocal injury in venous strokes and their differences from those in arterial strokes by urgent CT and MRI. Materials and methods. The diagnosis of a venous stroke was verifi ed by neurovisualization (native MSCT, perfusion CT or CT angiography, conventional MRI and MR-angiography) and during autopsy (in case of a fatal outcome). Results. Patients with venous strokes had a hyperdense (by routine CT) stroke-related vessel, compensatory venous distention on the side of the occlusion, early haemorrhagic transformation, the changes localized in the region of the affected vein. Conclusions. The study allowed to detect CT and MRI signs, which can help to differentiate arterial and venous strokes.