Background Cerebral venous thrombosis accounts for <5% of all strokes. Cortical vein thrombosis (CVT) is even rarer and usually coexists with sinus thrombosis but can present in isolation. As a group their presentation is with headache, focal cortical signs and seizures. Radiologically, patients present with unusual patterns of ischaemia or haemorrhage (particularly subcortical) and oedema in non-arterial territories. We reviewed the potential predisposing factors to thrombosis and discuss the relevance of variation of cortical venous anatomy to CVT and clinical outcome.
Methods Retrospective case analysis of seven patients with isolated CVT. The diagnosis of which was made from a combination of the clinical picture (headache, focal cortical deficit and seizures) and the presence of direct evidence of clot or non-arterial infarction or haemorrhage on standard MRI sequences in addition to perfusion MRV and CE MRV.
Results Of seven cases four were female, five patients presented with cerebral haemorrhage. Two patients had bilateral hemispheric involvement with three that involved the left hemisphere. Five patients presented with headache, all had focal neurological deficit and three had seizures. Five patients required heparin and six patients had good clinical outcome.
Conclusions The presence of headache, seizures and focal cortical signs with unusual non-arterial patterns of ischaemia/haemorrhage should alert clinicians to CVT. Variation in cortical venous drainage may potentiate CVT. In the absence of prompt diagnosis and aggressive treatment with hydration and anticoagulation patients are vulnerable to poor outcome.
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