Cerebral venous disorders: clinical presentation, diagnostic strategy, and contemporary management

Cerebral venous disorders encompass a heterogeneous group of conditions ranging from acute cerebral venous thrombosis to chronic intracranial venous hypertension and stenotic outflow states. Although historically considered uncommon, increasing recognition, improved imaging techniques, and expanding endovascular therapies have led to significant advances in the diagnosis and management of these conditions. This review provides a contemporary overview of the pathophysiology, clinical presentation, diagnostic evaluation, and treatment strategies for major cerebral venous disorders, with an emphasis on conditions associated with elevated intracranial venous pressure and medically refractory symptoms. We summarize current evidence regarding noninvasive and invasive imaging modalities, including the evolving roles of CT and MR venography, catheter venography, and physiologic pressure measurements. Indications for medical therapy, including anticoagulation and intracranial pressure management, are discussed alongside emerging criteria for patient selection for endovascular intervention. Particular attention is given to venous sinus stenting and other endovascular techniques, including technical considerations, outcomes, and complication profiles. Controversies remain regarding diagnostic thresholds, the clinical significance of venous stenosis, optimal hemodynamic criteria for intervention, and long-term durability of endovascular treatment. We highlight areas of ongoing investigation and identify key knowledge gaps that may inform future research. As diagnostic capabilities and therapeutic options continue to evolve, a multidisciplinary and physiology-guided approach is essential to optimize patient selection and outcomes in cerebral venous disorders.