A case of isolated cortical venous thrombosis presenting radiographically as a subacute multifocal leukoencephalopathy, and review of literature

Abstract

A 55-year-old man presented with brief seizure with associated acute aphasia, right head turn and subsequent generalised convulsion. On imaging, he was found to have patchy juxtacortical and cortical T2 hyperintensity with high radiographic suspicion for subacute multifocal leukoencephalopathy. Serum and cerebrospinal fluid testing were unremarkable. Clinically, the patient recovered completely and had no recurrence of symptoms. On follow-up MRI 1 month later, the T2 hyperintensity had resolved almost entirely while hypointensity on susceptibility-weighted angiography MRI remained, suggesting isolated cortical venous thrombosis.

Malignant Isolated Cortical Vein Thrombosis as the Initial Manifestation of Primary Antiphospholipid Syndrome: Lessons on Diagnosis and Management From a Case Report

“…Its propensity to mimic not only symptoms but also neuroradiological manifestations of numerous other diseases makes diagnosis particularly challenging ( 14 ). Misdiagnoses include acute ischemic stroke (AIS), cSAH, glioma, cerebral parasitic disease, and even multifocal leukoencephalopathy ( 15 ). Symptoms and signs such as seizures and motor and sensory disturbances are common in ICoVT, especially in the early stages, which results in the misdiagnosis of the underlying ICoVT ( 16 ).…”

“…NCCT is usually the first diagnostic tool used, especially for patients in the emergency department. The CT “cord sign” is the direct visualization of the thrombosed cortical veins, which present as cord-like hyperdensities in the cerebral sulcus ( 15 , 28 ). This sign is rare and has low diagnostic sensitivity for ICoVT.…”