Isolated cortical venous thrombosis: analysis of three cases and literature review
10.3760/cma.j.issn.1006?7876.2019.09.006
- VernacularTitle:孤立性皮质静脉血栓三例分析及文献回顾
- Author:
Yating WU
1
;
Lixin ZHOU
;
Fei HAN
;
Lu YANG
;
Xiaobo ZHANG
;
Dachun ZHAO
;
Bin PENG
Author Information
1. 中国医学科学院北京协和医院神经科
- Keywords:
Intracranial thrombosis;
Cerebral cortex;
Biopsy,meninges;
Magnetic resonance imaging;
Digital subtraction angiography
- From:
Chinese Journal of Neurology
2019;52(9):732-738
- CountryChina
- Language:Chinese
-
Abstract:
Objective Isolated cortical venous thrombosis (ICoVT) has a low incidence and is easily to be misdiagnosed. The clinical characteristics, diagnosis and treatment of three cases of ICoVT were analyzed in order to improve the level of diagnosis and treatment. Methods The clinical manifestations, examination, imaging and pathological features of three patients with ICoVT admitted to our hospital were retrospectively analyzed. Results All the three patients had acute onset. The main symptoms were headache, seizures, numbness of one limb and mental disorders. Intracranial pressure was normal. Brain magnetic resonance imaging (MRI) showed abnormal signals located in cortical sulcus and subcortex. Point and linear hypointensity could be seen on T2* or susceptibility weighted imaging (SWI)?weighted image. Digital subtraction angiography was performed in one case, showing occlusion of cortical veins. Protein S decreased in two patients, two patients with hyperhomocysteinemia and one patient with antiphospholipid antibody syndrome. The clinical and imaging manifestations of three patients were spontaneously alleviated. Brain biopsy was performed in two patients, and meningeal biopsy was performed in one patient due to significant meningeal thickening. Conclusions The clinical manifestations and routine MRI of ICoVT lack specificity and are easy to be misdiagnosed. However, ICoVT patients are often associated with risk factors for thrombophilia. T2* or SWI sequences are sensitive to the diagnosis of ICoVT. Brain biopsy has implications for the diagnosis and it is helpful for differential diagnosis, but the indications should be strictly controlled.
