Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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March 7, 2011
Isolated Cortical Vein Thrombosis
- Uncommon condition which often requires a high degree of clinical suspicion, since both the symptoms and imaging findings are non-specific.
- It is often seen in patients with leukemia, postpartum state, trauma, infections, medication (contraceptives), vasculitis, neoplasm, coagulopathic disorders, etc. In 25% of the cases, there is no identifiable cause.
- Focal neurological signs are the most common features, but focal epileptic seizures with secondary generalization are also seen.
- Key Diagnostic Features: MRI is the imaging study of choice. DWI will demonstrate infarct in the adjacent brain. Gradient echo and T2* images can demonstrate dark signal in the involved cortical vein ("cord sign"). Reduced venous flow in the medullary veins after contrast administration is sometimes seen.
- DDx: Subarachnoid hemorrhage, arachnoid granulation, cerebral hemorrhage
- Treatment: Anticoagulation
