Isolated cortical vein thrombosis in a young male adult

2021 ◽  
Vol 14 (6) ◽  
pp. e239988
Author(s):  
Lourdu Sireesha Pentareddy ◽  
Corina Cristina Nava Suarez ◽  
Darell Caesario ◽  
Stephen Jesmajian
Keyword(s):  
Brain Imaging ◽  
Sinus Thrombosis ◽  
Young Male ◽  
Male Adult ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis ◽  
Young Male Adult ◽  
High Index Of Suspicion ◽  
Work Up

Isolated cortical vein thrombosis (ICVT) is a rare entity and accounts for only 6.3% of cerebral venous and sinus thrombosis. ICVT is an uncommon cause of seizures in young adults. We present a 27-year-old man with no medical history who presented with dizziness, loss of consciousness and a seizure-like episode. The patient was found to have an elevated D-dimer and brain imaging revealed ICVT. The patient was started on anticoagulation and antiseizure medications. A high index of suspicion for uncommon aetiologies for new-onset seizure, especially in the young, is key to accurate diagnosis of ICVT. Evaluation and work-up should include detailed physical examination, along with appropriate brain imaging and testing for other conditions that predispose venous thrombosis. In the setting of the SARS-CoV-2 pandemic, testing for COVID-19 may also be warranted. Rapid diagnosis and full anticoagulation can help avoid debilitating complications and long-term sequelae.

Headache in cerebral venous sinus thrombosis revisited: Exploring the role of vascular congestion and cortical vein thrombosis

Cephalalgia ◽  
2017 ◽  
Vol 38 (3) ◽  
pp. 503-510 ◽  
Author(s):  
Ravinder-Jeet Singh ◽  
Jitender Saini ◽  
Shriram Varadharajan ◽  
Girish Baburao Kulkarni ◽  
Mustare Veerendrakumar
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Venous Sinus Thrombosis ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis ◽  
Vascular Congestion

Background and purpose Headache constitutes the most common symptom of cerebral venous sinus thrombosis (CVST), but its pathophysiology is unclear. We sought to investigate the potential mechanism for headache genesis in patients with CVST based on its imaging correlates. Methods A subgroup of CVST patients having headache as the predominant symptom without significant parenchymal lesion were retrospectively analysed for imaging features of vascular congestion (VC), in addition to cortical venous (CVT) and dural sinus thrombosis (DST) on magnetic resonance imaging. Headache and imaging patterns were classified into lateralized and nonlateralized phenotypes and their correlation was sought. Results Among 41 patients included, 28 had lateralized headache (LH group; 15 males; mean age 32.25 ± 9.19 years) while 13 had nonlateralized headache (non-LH group; six males; mean age 27.15 ± 8.65 years). Headache characteristics in both the groups were quite similar. Imaging showed VC in 39 of 41 and CVT among 35 of 41 patients, which were lateralized in 23 of 39 and 18 of 35 patients, respectively. Nearly all lateralized imaging patterns (21 of 23 for VC and 17 of 18 for CVT) occurred in the LH group and ipsilateral to (concordant) headache, while the non-LH group showed lateralized VC and CVT in only two and one patient respectively. Sinus thrombosis was lateralized in both groups irrespective of headache laterality. Whole cohort headache-imaging laterality (including patients with nonlateralized headache and nonlateralized imaging) concordance was 31 of 39, 24 of 35 and 18 of 41 for vascular congestion, cortical vein thrombosis and dural sinus thrombosis respectively. Conclusion Co-localization of VC and CVT with overlying headache might provide a possible explanation of headache and its laterality in patients with CVST.

scholarly journals Acute symptomatic seizures in cerebral venous thrombosis

Neurology ◽  
2020 ◽  
Vol 95 (12) ◽  
pp. e1706-e1715 ◽  
Author(s):  
Erik Lindgren ◽  
Suzanne M. Silvis ◽  
Sini Hiltunen ◽  
Mirjam R. Heldner ◽  
Fabiola Serrano ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Edema ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Sagittal Sinus ◽  
Cortical Vein Thrombosis ◽  
Symptomatic Seizures ◽  
Acute Symptomatic Seizures

ObjectiveTo identify characteristics, predictors, and outcomes of acute symptomatic seizures (ASS) in cerebral venous thrombosis (CVT), we investigated 1,281 consecutive adult patients with CVT included from 12 hospitals within the International CVT Consortium.MethodsWe defined ASS as any seizure between symptom onset and 7 days after diagnosis of CVT. We stratified ASS into prediagnosis and solely postdiagnosis ASS. Status epilepticus (SE) was also analyzed separately. We analyzed predictors for ASS and the association between ASS and clinical outcome (modified Rankin Scale) with multivariable logistic regression.ResultsOf 1,281 eligible patients, 441 (34%) had ASS. Baseline predictors for ASS were intracerebral hemorrhage (ICH; adjusted odds ratio [aOR] 4.1, 95% confidence interval [CI] 3.0–5.5), cerebral edema/infarction without ICH (aOR 2.8, 95% CI 2.0–4.0), cortical vein thrombosis (aOR 2.1, 95% CI 1.5–2.9), superior sagittal sinus thrombosis (aOR 2.0, 95% CI 1.5–2.6), focal neurologic deficit (aOR 1.9, 95% CI 1.4–2.6), sulcal subarachnoid hemorrhage (aOR 1.6, 95% CI 1.1–2.5), and female-specific risk factors (aOR 1.5, 95% CI 1.1–2.1). Ninety-three (7%) patients had solely postdiagnosis ASS, best predicted by cortical vein thrombosis (positive/negative predictive value 22%/92%). Eighty (6%) patients had SE, independently predicted by ICH, focal neurologic deficits, and cerebral edema/infarction. Neither ASS nor SE was independently associated with outcome.ConclusionASS occurred in one-third of patients with CVT and was associated with brain parenchymal lesions and thrombosis of the superficial system. In the absence of prediagnosis ASS, no subgroup was identified with sufficient risk of postdiagnosis ASS to justify prophylactic antiepileptic drug treatment. We found no association between ASS and outcome.

scholarly journals Cerebral Sinus Thrombosis Secondary to SARS-CoV-2 Infection

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Mojtaba Khazaei ◽  
Kiana Karimi ◽  
Parinaz Sedighi ◽  
Salman Khazaei
Keyword(s):  
Sinus Thrombosis ◽  
Neurological Complications ◽  
Transverse Sinus ◽  
Cerebral Vessel ◽  
Respiratory Problems ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis ◽  
Level Of Consciousness ◽  
Good General Condition

Coronavirus disease-19 (COVID‐19) is a novel infectious disease and every day we are learning more about its various clinical features and complications. Different studies during the pandemic have shown various neurological manifestations secondary to the infection such as stroke due to cerebral vessel thrombosis. Herein, we presented a 57-year-old man admitted to our hospital with gradual headache, seizure, and decreasing level of consciousness. Three weeks earlier, he was diagnosed with COVID-19 and mild to moderate respiratory problems. Decreased level of consciousness made physicians intubate the patient and initiate mechanical ventilation in the intensive care unit (ICU). Treatment was initiated with phenytoin. Brain CT scan showed right transverse sinus and cortical vein thrombosis with subarachnoid hemorrhage. He received successful anticoagulant therapy, with further improvement in oxygenation, and discharged with a good general condition. This case is important because several neurological complications of COVID-19 should be noticed and managed by appropriate treatment according to the patient’s condition.

scholarly journals Cerebellar cortical vein thrombosis mimicking a vermian tumor: case report

2017 ◽  
Vol 31 (3) ◽  
pp. 309-312 ◽  
Author(s):  
Marcelo D Vilela ◽  
Hugo AS Pedrosa ◽  
Marco Antonio D Filho
Keyword(s):  
Case Report ◽  
Sinus Thrombosis ◽  
Cerebellar Hemisphere ◽  
Dural Sinus ◽  
Cerebellar Tumor ◽  
Dural Sinus Thrombosis ◽  
Venous Infarction ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis

Cortical vein thrombosis is an uncommon cause of stroke and generally occurs in the supratentorial compartment. Spontaneous venous thrombosis with infarction in the posterior fossa usually occurs in association with either dural sinus thrombosis and/or thrombosis of the petrosal vein, usually with venous infarction of the cerebellar hemisphere. Our goal is to present the case of a patient with thrombosis of cerebellar cortical veins, without sinus involvement, which mimicked a vermian cerebellar tumor.

Chronic subdural hemorrhage predisposes to development of cerebral venous thrombosis and associated retinal hemorrhages and subdural rebleeds in infants

2021 ◽  
pp. 197140092110269
Author(s):  
Dale F Vaslow
Keyword(s):  
Sinus Thrombosis ◽  
Retinal Hemorrhage ◽  
Evidence Base ◽  
Venous Sinus ◽  
Subdural Hemorrhage ◽  
Minor Trauma ◽  
Venous Sinus Thrombosis ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis

For infants presenting with subdural hemorrhage, retinal hemorrhage, and neurological decline the “consensus” opinion is that this constellation represents child abuse and that cerebral venous sinus thrombosis and cortical vein thrombosis is a false mimic. This article contends that this conclusion is false for a subset of infants with no evidence of spinal, external head, or body injury and is the result of a poor radiologic evidence base and misinterpreted data. Underdiagnosis of thrombosis is the result of rapid clot dissolution and radiologic under recognition. A pre-existing/chronic subdural hemorrhage predisposes to development of venous sinus thrombosis/cortical vein thrombosis, triggered by minor trauma or an acute life-threatening event such as dysphagic choking, variably leading to retinal and subdural hemorrhages and neurologic decline. These conclusions are based on analysis of the neuroradiologic imaging findings in 11 infants, all featuring undiagnosed cortical vein or venous sinus thrombosis. Subtle neuroradiologic signs of and the mechanisms of thrombosis are discussed. Subarachnoid hemorrhage from leaking thrombosed cortical veins may be confused with acute subdural hemorrhage and probably contributes to the development of retinal hemorrhage ala Terson’s syndrome. Chronic subdural hemorrhage rebleeding from minor trauma likely occurs more readily than bleeding from traumatic bridging vein rupture. Radiologists must meet the challenge of stringent evaluation of neuro imaging studies; any infant with a pre-existing subdural hemorrhage presenting with neurologic decline must be assumed to have venous sinus or cortical vein thrombosis until proven otherwise.

scholarly journals Cerebral venous thrombosis following spontaneous intracranial hypotension diagnosed by craniotomy: A case report and diagnostic pitfalls

2021 ◽  
Vol 12 ◽  
pp. 367
Author(s):  
Shigeomi Yokoya ◽  
Hideki Oka ◽  
Akihiko Hino
Keyword(s):  
Intracranial Hypotension ◽  
Sinus Thrombosis ◽  
Fluid Pressure ◽  
Spontaneous Intracranial Hypotension ◽  
Dural Sinus ◽  
Cerebral Vein ◽  
Imaging Findings ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis

Background: Cerebral vein and dural sinus thrombosis (CVT) is a rare but important complication of spontaneous intracranial hypotension (SIH). The diagnosis is difficult in cases lacking typical symptoms and typical imaging findings. Case Description: A 29-year-old male patient with a seizure attack was admitted to our hospital. Based on the head imaging findings, we misdiagnosed the patient with primary cerebral parenchymal lesion and performed an open biopsy. However, during the procedure, the patient was diagnosed with low cerebrospinal fluid pressure and cerebral cortical vein thrombosis. Conclusion: Thus, CVT due to SIH should be considered as a probable cause of secondary parenchymal lesions.

Cortical Vein Thrombosis in a Case of Clinically Isolated Syndrome and Psoriasis—A Case Report and Review of Literature

2021 ◽  
pp. 251660852199857
Author(s):  
Jagadish B. Agadi ◽  
Lakshminarayanapuram Gopal Viswanathan ◽  
Sujit Kumar ◽  
Manithody Narayan-Bhat Pramod
Keyword(s):  
Sinus Thrombosis ◽  
Clinically Isolated Syndrome ◽  
Severe Headache ◽  
Review Of Literature ◽  
Rare Finding ◽  
Venous Sinus Thrombosis ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Multiple Factors ◽  
Cortical Vein Thrombosis

Cortical vein/venous sinus thrombosis (CVT) occurring in the context of a clinically isolated syndrome (CIS) is highly unusual. Our patient presented with dorsal cord demyelination and psoriasis. She developed severe headache post-lumbar puncture, which was followed by focal seizures. She had developed CVT with a hemorrhagic infarct in the left parietal region. Multiple factors, both patient related and as a consequence of treatment and management, may have contributed to this outcome. We aim to discuss the relevance of this rare finding with a brief review of literature.

Multimodal diagnosis of cortical vein thrombosis

2007 ◽  
Vol 34 (S 2) ◽  
Author(s):  
J Linn ◽  
T Pfefferkorn ◽  
S Michl ◽  
M Wiesmann ◽  
S Hartz ◽  
...  
Keyword(s):  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis

scholarly journals Cerebellar venous thrombosis mimicking a cerebellar tumor due to polycythemia vera: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hongfeng Wen ◽  
Di Jin ◽  
Yu Chen ◽  
Bin Cui ◽  
Tianyi Xiao
Keyword(s):  
Venous Thrombosis ◽  
Polycythemia Vera ◽  
Delayed Diagnosis ◽  
Janus Kinase ◽  
Cerebellar Hemisphere ◽  
Cerebellar Tumor ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis ◽  
V617f Mutation

Abstract Background Cerebral venous thrombosis (CVT) occurs rarely in the general population and is frequently associated with confused clinical findings and delayed diagnosis. Isolated cerebellar cortical vein thrombosis is a very rare phenomenon. Case presentation This report describes a case with CVT, which is manifested as space-occupying lesions of the cerebellar hemisphere and mimics a cerebellar tumor at the beginning. The diagnosis of CVT was finalized given the laboratory and brain biopsy findings. The etiology may be related to polycythemia vera with Janus Kinase 2 V617F mutation. Conclusion Isolated cerebellar vein thrombosis should be considered when swelling and enhancing cerebellar lesions are detected. Polycythemia vera, especially with a positive JAK2 V617F mutation, may be a rare risk factor for CVT.

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