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June 15, 2015: Cortical vein thrombosis

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Brought to you by the Residents & Fellows Section of Neurology.

June 15, 2015

Cortical vein thrombosis

Isolated cortical vein thrombosis is a rare cause of stroke and can present with general neurologic symptoms such as headache and seizure or localization-dependent signs1. Treatment options are extrapolated from management guidelines in cerebral venous thrombosis and include anticoagulation or thrombolytic therapies. However, diagnosis can be difficult as parenchymal lesions suggestive of venous infarct may be seen in less than two-thirds of patients; as such, the interval from symptom onset to diagnosis averaging seven days1. Risk factors include pregnancy, oral contraceptive use, lumbar puncture, and infection. MRI can be effective in detecting cortical vein thrombosis, though T2*-gradient echo sequences more so than magnetic resonance venography likely enhance the yield, owing to the susceptibility effects seen with elevated intraluminal deoxyhemoglobin2. If there is sufficient suspicion, conventional digital subtraction angiography may be required for accurate diagnosis.

References

  1. Coutinho JM, Gerritsma JJ, Zuurbier SM, Stam J. Isolated cortical vein thrombosis: systematic review of case reports and case series. Stroke 2014; 45: 1836-1838.
  2. Rathakrishnan R, Sharma VK, Hock Luen T, Chan BP. The clinico-radiological spectrum of isolated cortical vein thrombosis. Journal of Clinical Neuroscience 2011; 18: 1408-1411.

Submitted by Adam Numis, MD, Department of Neurology, University of California, Los Angeles.

Disclosures: Dr. Numis is a member of the Residents & Fellows Section of Neurology.

For more clinical pearls and other articles of interest to neurology trainees, visit Neurology. Listen to this week's Neurology Podcast.

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