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Analysis of Seven Cases With Review of the Literature

Stephen C. Crawford, MD; Kathleen B. Digre, MD; Cheryl A. Palmer, MD; D. Antonio Bell, MD; Anne G. Osborn, MD

Arch Neurol. 1995;52(11):1101-1108.

Abstract
Objectives
To characterize the clinical, radiographic, and pathologic findings in thrombosis of the deep venous drainage of the brain. To highlight clinical and radiographic findings that may lead to the diagnosis of disease and distinguish it from dural sinus thrombosis. To review the published literature on this disorder.

Design
Retrospective review of the medical and radiographic records of seven patients from three institutions over the past 10 years. Review of the English language literature from 1971 to the present.

Results
All seven patients had risk factors for cerebral venous thrombosis. Five patients presented with a short, rapidly progressing course characterized by headache, nausea and vomiting, and decline in level of consciousness. All five patients died or were rendered severely disabled. Computed tomographic scans, magnetic resonance imaging, and magnetic resonance angiography showed findings associated with deep cerebral vein thrombosis in three of four, in five of five, and in three of three patients, respectively. Transfemoral catheter angiography was diagnostic in two of two patients. Twenty-one reported cases of deep cerebral venous thrombosis were identified in the literature.

Conclusions
When the two populations are combined and compared with large series of patients with dural sinus thrombosis, patients with deep venous system thrombosis are more commonly women, tend to present with a more rapidly declining time course, altered consciousness, and long tract signs. Death or long-term sequelae are far more likely to occur in internal cerebral vein thrombosis than with dural sinus thrombosis. Unenhanced computed tomography can demonstrate findings that are strongly suggestive of the diagnosis. Magnetic resonance imaging and magnetic resonance angiography are confirmatory. Angiography may still be necessary when the diagnosis is not clear.

Author Affiliations
From the Department of Radiology, St Cloud Hospital, St Cloud, Minn (Dr Crawford); Departments of Neurology and Ophthalmology (Dr Digre) and Radiology (Drs Bell and Osborn), University of Utah, Salt Lake City; and Departments of Pathology and Neurology, University of Alabama at Birmingham (Dr Palmer). Dr Bell is now with Bowman-Gray School of Medicine, Winston-Salem, NC; and Dr Crawford, the University of Mississippi, Jackson.

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