THROMBOSIS OF THE DEEP VENOUS DRAINAGE OF THE BRAIN IN ADULTS - ANALYSIS OF 7 CASES WITH REVIEW OF THE LITERATURE

Objectives: To characterize the clinical, radiographic, and pathologic findings in thrombosis of the deep venous drainage of the brain. To h ighlight clinical and radiographic findings that may lead to the diagn osis of disease and distinguish it from dural sinus thrombosis. To rev iew the published literature on this disorder. Design: Retrospective r eview of the medical and radiographic records of seven patients from t hree institutions over the past 10 years. Review of the English langua ge literature from 1971 to the present. Results: All seven patients ha d risk factors for cerebral venous thrombosis. Five patients presented with a short, rapidly progressing course characterized by headache, n ausea and vomiting, and decline in level of consciousness. All five pa tients died or were rendered severely disabled. Computed tomographic s cans, magnetic resonance imaging, and magnetic resonance angiography s howed 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 patie nts. Twenty-one reported cases of deep cerebral venous thrombosis were identified in the literature. Conclusions: When the two populations a re combined and compared with large series of patients with dural sinu s thrombosis, patients with deep venous system thrombosis are more com monly women, tend to present with a more rapidly declining time course , altered consciousness, and long tract signs. Death or long-term sequ elae 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. Ma gnetic resonance imaging and magnetic resonance angiography are confir matory. Angiography may still be necessary when the diagnosis is not c lear.