Head trauma causes a number of neuroophthalmic manifestations. The afferent and efferent pathways are vulnerable to traumatic injury, although the efferent system is more commonly affected. Loss of consciousness may not be a reliable predictor of specific neuro-ophthalmic outcomes, but neuroimaging abnormalities may.

Background and Purpose —A novel sequence variation in the 3′-untranslated region of the prothrombin (factor II) gene (nucleotide 20210 G→A) has been recently described as a risk factor for deep vein thrombosis and pulmonary embolism. It is found in ≈1% to 4% of healthy subjects. We studied the frequency of this factor II variant in patients with cerebral venous thrombosis. Methods —The 20210A allele of the prothrombin gene was studied after DNA extraction, polymerase chain reaction amplification, and Hin dIII digestion in 35 patients with magnetic resonance imaging or angiographically confirmed cerebral venous thrombosis (23 women and 12 men, aged 11 to 71 years). Results —Two patients (5.7%) had the 20210A allele of the prothrombin gene. Both had other risk factors for thrombosis (use of oral contraceptives and of intrathecal steroids). Conclusions —The 20210A allele of the prothrombin gene in association with other prothrombic factors may increase the risk of cerebral venous thrombosis, but case-control studies will be necessary to clarify these associations.

Congenital and acquired hypercoagulable states arise from an imbalance between procoagulant and anticoagulant forces. Although these conditions are present throughout the vascular tree, they typically give rise to local thrombotic lesions in discrete segments of the veins or arteries; this suggests that focal defects in the vascular wall or blood flow must be associated with a hypercoagulable state to produce thrombosis. Numerous new factors associated with hypercoagulability have been described in the past few years. Congenital and acquired hypercoagulable states are reviewed here, with an emphasis on recent data on focal thrombosis involving the eye and central nervous system.