Susceptibility-Weighted MR Imaging for the Detection of Isolated Cortical Vein Thrombosis in a Patient with Spontaneous Intracranial Hypotension

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.

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Spontaneous Intracranial Hypotension with Isolated Cortical Vein Thrombosis and Subarachnoid Haemorrhage

Cephalalgia ◽

10.1111/j.1468-2982.2007.01437.x ◽

2007 ◽

Vol 27 (12) ◽

pp. 1413-1417 ◽

Cited By ~ 26

Author(s):

Y-F Wang ◽

J-L Fuh ◽

J-F Lirng ◽

F-C Chang ◽

S-J Wang

Keyword(s):

Subarachnoid Haemorrhage ◽

Venous Thrombosis ◽

Intracranial Hypotension ◽

Venous Blood ◽

Spontaneous Intracranial Hypotension ◽

Brain Magnetic Resonance Imaging ◽

Venous Blood Flow ◽

Cortical Vein ◽

Cortical Vein Thrombosis ◽

Cortical Venous Thrombosis

Spontaneous intracranial hypotension (SIH) associated with subarachnoid haemorrhage (SAH) has never been reported. Here, we report on a case of a 33-year-old woman with SIH, who developed simple partial sensory seizures 3 weeks later. Neuroimaging studies, including brain computed tomography and angiography, were initially normal, but revealed an isolated cortical venous thrombosis at 3 weeks. One week later, brain magnetic resonance imaging showed SAH around the thrombosed cortical vein. We postulate that the decline in the venous blood flow velocity due to SIH may have resulted in cortical venous thrombosis, which in turn led to rupture of the vessel wall and SAH in this patient.

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Diffusion-Weighted MR Imaging Findings of Cortical Vein Thrombosis at 3 T

Clinical Neuroradiology ◽

10.1007/s00062-014-0301-y ◽

2014 ◽

Vol 25 (3) ◽

pp. 249-256 ◽

Cited By ~ 6

Author(s):

M. E. Yıldız ◽

U. A. Ozcan ◽

A. Turk ◽

O. S. Ulus ◽

C. Erzen ◽

...

Keyword(s):

Mr Imaging ◽

Imaging Findings ◽

Cortical Vein ◽

Vein Thrombosis ◽

Diffusion Weighted ◽

Cortical Vein Thrombosis

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Isolated cortical vein thrombosis: case series

Journal of Neurosurgery ◽

10.3171/2014.9.jns141813 ◽

2015 ◽

Vol 123 (2) ◽

pp. 427-433 ◽

Cited By ~ 17

Author(s):

Ranjodh Singh ◽

William P. Cope ◽

Zhiping Zhou ◽

Michelle E. De Witt ◽

John A. Boockvar ◽

...

Keyword(s):

Risk Factors ◽

Intracranial Hypotension ◽

Vasogenic Edema ◽

Anticoagulation Therapy ◽

Case Series ◽

Published Data ◽

Cortical Vein ◽

Vein Thrombosis ◽

Presenting Symptoms ◽

Cortical Vein Thrombosis

OBJECT Isolated cortical vein thrombosis (ICVT) accounts for less than 1% of all cerebral infarctions. ICVT may cause irreversible parenchymal damage, rendering early and accurate diagnosis critical. This case series and literature review presents the clinical and radiological findings in 7 patients with ICVT, and highlights risk factors and imaging modalities that may be most beneficial in rendering an accurate and timely diagnosis. METHODS Patients with CT and MRI findings consistent with ICVT examined between January 2011 and June 2014 were included in this retrospective review. RESULTS Seven patients (5 females, 2 males), ranging in age from 11 months to 34 years, met the inclusion criteria. The most common clinical presentations were headaches (n = 4) and seizures (n = 3). The most common comorbidities noted in these patients were hypercoagulable states (n = 4) and intracranial hypotension (n = 3). Five patients had intraparenchymal involvement. CT suggested the correct diagnosis in 4 patients, and MRI confirmed the diagnosis in all 7 patients. All patients who received anticoagulation therapy (n = 5) experienced complete resolution of their symptoms. CONCLUSIONS The majority of these patients were adult females, consistent with published data. Seizures and headaches were the most common presenting symptoms. Hypercoagulable state and intracranial hypotension, both known risk factors for thrombosis, were the most commonly noted ICVT risk factors. Intraparenchymal involvement was prevalent in nearly all ICVT cases and presented as vasogenic edema, early intraparenchymal hemorrhage, or hemorrhagic venous infarction. Susceptibility-weighted imaging was the most sensitive imaging technique in diagnosing ICVT.

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P.013 Convulsive status epilepticus due to intracranial hypotension

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.115 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S19-S19

Author(s):

GS Gilmour ◽

J Scott ◽

P Couillard

Keyword(s):

Status Epilepticus ◽

Intracranial Hypotension ◽

Chronic Back Pain ◽

Case Reports ◽

Convulsive Status Epilepticus ◽

Scoliosis Surgery ◽

Cortical Vein ◽

Vein Thrombosis ◽

Epileptiform Discharges ◽

Cortical Vein Thrombosis

Background: Intracranial hypotension (IH) is typically characterized by an orthostatic headache. There have been limited case reports describing iatrogenic IH presenting with seizures. Methods: Case report. Results: A 71-year-old woman with chronic back pain developed convulsive status epilepticus (SE), characterized by generalized clonic seizures, immediately following scoliosis surgery. She had no history of seizures or seizure risk factors. Despite treatment with Midazolam, Phenytoin and Lacosamide, seizures recurred five times over three hours. Thus, Propofol and Midazolam infusions were initiated. An electroencephalogram revealed burst suppression and bilateral hemispheric epileptiform discharges. MRI brain was consistent with IH without cortical vein thrombosis. Fluid from the surgical drains was positive for Beta-2 transferrin, indicating cerebral spinal fluid. Her intracranial hypotension was likely due to an -intraoperative dural tear causing SE. Over two weeks, she remained on bedrest, sedation was weaned, and Phenytoin and Lacosamide were tapered and discontinued. She had no further seizures. Conclusions: IH is an under recognized cause of seizure following spinal or cranial surgery, lumbar puncture, or spinal anaesthesia. Proposed mechanisms include traction on cortical structures, increased cerebral blood flow and cortical irritation secondary to subdural hygromas.

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New experimental model of sinus and cortical vein thrombosis in pigs for MR imaging studies

Neuroradiology ◽

10.1007/s00234-006-0125-9 ◽

2006 ◽

Vol 48 (10) ◽

pp. 721-729 ◽

Cited By ~ 10

Author(s):

C. P. Stracke ◽

E. Spuentrup ◽

M. Katoh ◽

R. W. Günther ◽

P. Spangenberg

Keyword(s):

Mr Imaging ◽

Experimental Model ◽

Imaging Studies ◽

Cortical Vein ◽

Vein Thrombosis ◽

Cortical Vein Thrombosis

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MR Imaging Features of Isolated Cortical Vein Thrombosis: Diagnosis and Follow-Up

American Journal of Neuroradiology ◽

10.3174/ajnr.a1332 ◽

2008 ◽

Vol 30 (2) ◽

pp. 344-348 ◽

Cited By ~ 85

Author(s):

M. Boukobza ◽

I. Crassard ◽

M.G. Bousser ◽

H. Chabriat

Keyword(s):

Mr Imaging ◽

Imaging Features ◽

Cortical Vein ◽

Vein Thrombosis ◽

Cortical Vein Thrombosis

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Multimodal diagnosis of cortical vein thrombosis

Aktuelle Neurologie ◽

10.1055/s-2007-987497 ◽

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

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

BMC Neurology ◽

10.1186/s12883-021-02261-1 ◽

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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