Venous Thrombosis and Infarction 

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BACKGROUND AND CLINICAL INFORMATION: Head  

Overall mortality is about 5.5-33%. Early recognition an early recanalization of the thrombosed vessels greatly reduced the motality. Otherwise, the prognosis is grave.

Thrombolytic therapy will not lead to the expansion of the hemorrhage as in thrombosis of arterial origin.

Can occur in all ages. Associates with the use of oral contraceptives and pregnancy. The other major cause is infection leading to thrombosis of the cavernous sinus, sphenoid sinus, and lateral sinus.

GROSS PATHOLOGY: Head

The brain has very good venous collaterals. Therefore, thrombosis must usually be fairly extnesive before an infarction can be resulted.

Common sites are: superior sagittal sinus (72%), lateral sinuses (70% combined), and straight sinus (13%). Thrombosis commonly extends to several sinuses and veins.

Thrombosis of cerebral veins, especially the cortically ones, rarely results in tissue damage, but thrombosis of the deep internal veins and the great vein of Galen may cause severe damage to the basal ganglia and brain stem.

Macroscopically, the hemorrhagic infarct may extend from the thrombosed vein to the white matter.

DIFFERENTIAL DIAGNOSIS: Head  

Venous thrombosis can be confused with contusion. The pial surface in venous thrombosis, in contrast to arterial infarction, can be disrupted. On the other hand, the vessels in contusion can be very congested and suggest thrombosis. History is helpful. 

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For Comment: KarMing-Fung@ouhsc.edu