An encephalopathy may develop in a patient with venous congestion affecting the venous drainage from the brain.

Conditions that may lead to congestive encephalopathy:

(1) central venous occlusive disease, typically in a patient on chronic hemodialysis

(2) cranial dural arteriovenous fistula

(3) portal hypertension

(4) heart failure with fluid overload


The encephalopathy may be generalized or focal. A dural arteriovenous fistula in the posterior fossa may cause an encephalopathy that primarily affects the brainstem.


Clinical findings may include:

(1) altered mental status

(2) extensor rigidity

(3) hemiparesis

(4) nonreactive pupils and/or papilledema

(5) delirium

(6) headache

(7) seizures

(8) cognitive dysfunction


The findings may appear or be made worse by surgery.



(1) cerebral edema

(2) cerebral infarction

(3) moderate to severe disabilities


The condition can have a poor prognosis even if the venous congestion can be reduced, especially when there has been cerebral infarction.

To read more or access our algorithms and calculators, please log in or register.