Pathogenesis and Management in Cerebrovenous Outflow Disorders

Chaobo Bai; Zhongao Wang; Christopher Stone; Da Zhou; Jiayue Ding; Yuchuan Ding; Xunming Ji; Ran Meng

doi:10.14336/AD.2020.0404

Pathogenesis and Management in Cerebrovenous Outflow Disorders

Aging Dis. 2021 Feb 1;12(1):203-222. doi: 10.14336/AD.2020.0404. eCollection 2021 Feb.

Authors

Chaobo Bai^{1

2

3}, Zhongao Wang^{1

2

3}, Christopher Stone⁴, Da Zhou^{1

2

3}, Jiayue Ding^{1

2

3}, Yuchuan Ding^{3

4}, Xunming Ji^{2

3

5}, Ran Meng^{1

2

3}

Affiliations

¹ 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
² 2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
³ 3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁴ 4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
⁵ 5Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Abstract

In keeping with its status as one of the major causes of disability and mortality worldwide, brain damage induced by cerebral arterial disease has been the subject of several decades of scientific investigation, which has resulted in a vastly improved understanding of its pathogenesis. Brain injury mediated by venous etiologies, however, such as cerebral, jugular, and vertebral venous outflow disturbance, have been largely ignored by clinicians. Unfortunately, this inattention is not proportional to the severity of cerebral venous diseases, as the impact they exact on the quality of life of affected patients may be no less than that of arterial diseases. This is evident in disease sequelae such as cerebral venous thrombosis (CVT)-mediated visual impairment, epilepsy, and intracranial hypertension; and the long-term unbearable head noise, tinnitus, headache, dizziness, sleeping disorder, and even severe intracranial hypertension induced by non-thrombotic cerebral venous sinus (CVS) stenosis and/or internal jugular venous (IJV) stenosis. In addition, the vertebral venous system (VVS), a large volume, valveless vascular network that stretches from the brain to the pelvis, provides a conduit for diffuse transmission of tumors, infections, or emboli, with potentially devastating clinical consequences. Moreover, the lack of specific features and focal neurologic signs seen with arterial etiologies render cerebral venous disease prone to both to misdiagnoses and missed diagnoses. It is therefore imperative that awareness be raised, and that as comprehensive an understanding as possible of these issues be cultivated. In this review, we attempt to facilitate these goals by systematically summarizing recent advances in the diagnosis and treatment of these entities, including CVT, CVS stenosis, and IJV stenosis, with the aim of providing a valid, practical reference for clinicians.

Keywords: cerebral venous sinus stenosis; cerebral venous thrombosis; diagnosis; internal jugular vein stenosis; treatment.

Publication types

Review