Isolated thrombosis of cortical veins – Clinical and radiological correlation

Murumkar, Vivek; Goyal, Sheetal; Baishya, Priyanka Priyadarshini; Peer, Sameer; Lanka, Vivek; Kulanthaivelu, Karthik; Saini, Jitender; Kenchaiah, Raghavendra; Reddy, Yerasi Varun; Bhat, Maya

doi:10.1016/j.jocn.2021.07.018

Cited by 6 publications

(22 citation statements)

References 23 publications

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“…It is well-established that ICoVT is the rarest subtype of CVST that presents as an isolated occlusion of anastomotic surface veins ( 2 , 14 ). It remains a poorly understood condition without established guidelines for rapid identification or precise treatment.…”

Section: Discussionmentioning

confidence: 99%

“…It is not surprising that ICoVT shares similar sex and age distribution, predisposing factors, and clinical presentations as CVST ( 2 , 14 ). Although female sex predilection and young individuals are well-established factors ( 2 , 14 ), there are some differences in predisposing factors between ICoVT and CVST. Murumkar and colleagues recently conducted the largest retrospective observational study to date of ICoVT involving 28 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Murumkar and colleagues recently conducted the largest retrospective observational study to date of ICoVT involving 28 patients. They concluded that iron deficiency anemia, hyperhomocysteinemia, infection, and female hormonal imbalance were the top 4 risk factors ( 2 ). Systemic autoimmune diseases were rarely considered the cause of ICoVT in their cohort, and only one patient with mixed connective tissue disease was reported.…”

Section: Discussionmentioning

confidence: 99%

“…Isolated cortical vein thrombosis (ICoVT) is a relatively rare and poorly understood phenomenon that represents <0.1% of all stroke entities and 6%–8.7% of all cerebral venous sinus thrombosis (CVST) cases ( 1 , 2 ). ICoVT is defined as thrombosis that only involves the cortical veins (CoVs) without occlusion of the dural venous sinuses and deep veins ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

“…In contrast to patients with CVST, patients with ICoVT often have parenchymal involvement (81% vs. 40.1%, respectively) and hemorrhagic lesions (46% vs. 13.4%, respectively) ( 3 , 4 ). Although most ICoVT patients achieve a favorable prognosis, delays in diagnosis and treatment can lead to life-threatening consequences ( 2 , 3 ). Additionally, it is important to note that CoV involvement is strongly associated with malignant CVST, which is defined as a supratentorial cortical venous infarction alongside malignant brain edema, leading to transtentorial herniation either at onset or after exacerbation ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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BackgroundAntiphospholipid syndrome (APS) with isolated cortical vein thrombosis (ICoVT) is an extremely rare but potentially malignant entity. It is particularly challenging to diagnose APS-related ICoVT because of the non-specific clinical manifestations and the frequent absence of typical neuroimaging. Moreover, there is currently limited knowledge on the clinical features and management strategies for the condition. Delays in diagnosis and treatment may lead to life-threatening consequences.Case PresentationWe present a rare case of a 74-year-old Chinese woman who presented with sudden onset of headache and right arm weakness that mimicked acute ischemic stroke. Her initial computed tomography was unremarkable, and intravenous thrombolysis was performed. Serial neuroimages confirmed ICoVT 4 days after symptom onset, and low-molecular-weight heparin (LMWH) was started at a dose of 0.4 ml twice per day, according to the 2019 Chinese guidelines. The workup for the predisposing causes of ICoVT revealed triple positivity APS. LMWH dose was adjusted according to the anti-Xa chromogenic assay. However, the patient’s condition deteriorated rapidly, and there was a progressive enlargement of the venous infarction despite treatment with anticoagulants. Transtentorial herniation developed on day 12, and decompressive craniectomy was immediately performed. The patient’s symptoms did not improve significantly after surgery, and she remained aphasic and hemiplegic at the 3-month follow-up, with a modified Rankin Scale score of 5.ConclusionICoVT is a rare yet potentially fatal manifestation of APS, and its diagnosis and treatment are extremely challenging. Timely diagnosis, prompt treatment, and close monitoring are essential to improve the clinical prognosis of patients with APS-related ICoVT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Cerebral Venous Thrombosis Due to Vaccine-Induced Thrombotic Thrombocytopenia

Al-Mayhani,

Perry

2024

Stroke Medicine

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Detection of cerebral cortical vein thrombosis with high-resolution susceptibility weighted imaging — A comparison with MR venography and standard MR sequences

et al. 2023

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Purpose Comparison of the performance of high-resolution susceptibility weighted imaging with standard MR sequences and MR venography to identify cortical vein clots. Methods A retrospective review of 51 consecutive cases of cerebral venous thrombosis and 27 controls was performed with independent analysis of all MR sequences. Reference standard was obtained with consensus in a separate session by reviewing all MR sequences together. Results Cortical vein clots were observed in 30 cases including 9 males and 21 females in the age range of 1 month to 70 years (Mean 34.9 ± 20.2 years). Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of susceptibility weighted imaging for the identification of cortical vein clots were 0.93, 1.0, 1.0, 0.96 and 0.97 respectively. For all other sequences, sensitivity ranged from 0.06 to 0.39 and accuracy from 0.60 to 0.73. Combination of all sequences yielded a value of 1.0 for sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the detection of cortical vein clots. Significant result for area under the receiver operating curve was observed only for SWI with a value of 0.91 ( p - .000). Conclusion Susceptibility weighted imaging demonstrates the best sensitivity and accuracy among standard MR sequences including MR venography for the detection of early stage cortical vein clots. However, it needs to be interpreted in combination with other MR sequences for the most accurate evaluation of cortical vein clots. Supplementary Information The online version contains supplementary material available at 10.1007/s00234-023-03123-y.

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Isolated thrombosis of cortical veins – Clinical and radiological correlation

Cited by 6 publications

References 23 publications

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

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

Cerebral Venous Thrombosis Due to Vaccine-Induced Thrombotic Thrombocytopenia

Detection of cerebral cortical vein thrombosis with high-resolution susceptibility weighted imaging — A comparison with MR venography and standard MR sequences

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