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The spectrum of presentations of venous infarction caused by deep cerebral vein thrombosis

From the Departments of Neurology (Drs. van den Bergh and van Gijn) and Radiology (Dr. van der Schaaf), University Medical Center Utrecht, The Netherlands.

Address correspondence and reprint requests to Dr van den Bergh, Department of Neurology, Room G03.124, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; e-mail: w.m.vandenbergh{at}neuro.azu.nl

The classic features of thrombosis of the deep cerebral venous system are severe dysfunction of the diencephalon, reflected by coma and disturbances of eye movements and pupillary reflexes, resulting in poor outcome. However, partial syndromes without a decrease in the level of consciousness or brainstem signs exist, which may lead to initial misdiagnoses. The spectrum of clinical symptoms reflects the degree of venous congestion, which depends not only on the extent of thrombosis in the deep veins but also on the territory of the involved vessels and the establishment of venous collaterals. For example, thrombosis of the internal cerebral veins with (partially) patent basal veins and sufficient collaterals may result in relatively mild symptoms. Deep cerebral venous system thrombosis is an underdiagnosed condition when symptoms are mild, even in the presence of a venous hemorrhagic congestion. Identification of venous obstruction has important therapeutic implications. The diagnosis should be strongly suspected if the patient is a young woman, if the lesion is within the basal ganglia or thalamus, and especially if it is bilateral.

Received May 28, 2004. Accepted in final form March 3, 2005.

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				Z. Morcos, W. M. van den Bergh, I. van der Schaaf, and J. van Gijn The spectrum of presentations of venous infarction caused by deep cerebral vein thrombosis Neurology, April 25, 2006; 66(8): 1284 - 1284. [Full Text] [PDF]

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