ДИАГНОСТИКА ВЕНОЗНОГО ИШЕМИЧЕСКОГО ИНСУЛЬТА. ЧАСТЬ II (АЛГОРИТМЫ И СЕМИОТИКА ЛУЧЕВОЙ ДИАГНОСТИКИ. ОГРАНИЧЕНИЯ ИСПОЛЬЗОВАНИЯ В КЛИНИЧЕСКОЙ ПРАКТИКЕ). ОБЗОР

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.