We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Central Retinal Venous Occlusion and Cerebral Venous Thrombosis

Tanya N. Turan, MD; Valérie Biousse, MD; Nancy J. Newman, MD
Arch Neurol. 2007;64(4):609. doi:10.1001/archneur.64.4.609-a.
Text Size: A A A
Published online


We read with interest the recently published observation by Lee and colleagues.1 The authors claim that their patient with cerebral venous thrombosis also had concomitant bilateral central retinal venous occlusion (CRVO), which was successfully treated with anticoagulation. Based on their report, the authors infer efficacy of low-molecular-weight heparin for the treatment of CRVO.

We have carefully reviewed the fundus photographs and the ophthalmologic findings and we have some concerns regarding the authors' diagnostic conclusions. Indeed, these findings are more suggestive of bilateral papilledema resulting from raised intracranial pressure rather than bilateral CRVO. Both optic nerves are swollen with exudates, cotton-wool spots, and peripapillary hemorrhages. The amount of swelling and optic nerve elevation is more than what is usually seen in CRVO. The venous dilation is moderate and is typically seen in severe papilledema. Furthermore, there are no retinal hemorrhages or retinal edema distant from the optic nerve like what would have been found in CRVO. Retinal fluorescein angiography would likely have shown normal venous filling, thereby ruling out CRVO, but this was either not performed or not reported. Given the clinical history and ophthalmologic findings provided, a more likely explanation is that the observed disc edema was due to raised intracranial pressure from cerebral venous thrombosis. The patient's visual improvement after anticoagulation treatment, therefore, was most likely due to normalization of the intracranial pressure with treatment of the underlying cerebral venous thrombosis.2

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections