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.
Complications:
(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.
