Venous ischemic syndromes

Abstract

Venous ischemic syndromes represent a rare type of cerebrovascular disease that more commonly affects young women. Because of the remarkable variability of clinical presentations and neuroimaging signs, these syndromes represent an important clinical challenge. The most common clinical presentations include headache, seizures, focal neurological deficits, altered consciousness, and papilledema, which can present in isolation or in association with other symptoms. According to the grouping of symptoms and signs, four main patterns have been identified: isolated intracranial hypertension, focal syndrome, cavernous sinus syndrome, and subacute encephalopathy. CT scan is commonly performed as the first-line diagnostic test, in most cases showing indirect signs such as cerebral edema, ischemic or hemorrhagic lesions, or signs of venous stasis. The most accurate diagnostic techniques to objectively confirm the diagnosis include magnetic resonance angiography and computed tomography angiography. Clinical presentations and neuroimaging signs are important predictors of outcome following venous ischemic syndromes. Coma, epileptic seizures and intracranial hemorrhage were shown, among others, to be independent predictors of poor outcome.