Pathological confirmation of 4 cases with isolated cortical vein thrombosis previously misdiagnosed as brain tumor

Abstract

Isolated cortical vein thrombosis (ICoVT) is a rare form of cerebral venous thrombosis and is easily misdiagnosed as brain tumor due to its atypical clinical presentations and radiological findings similar to brain tumors. The present study focused on 4 patients with ICoVT, 2 men and 2 women. In the 2 male patients, the onset of disease was insidious, with progressive numbness and weakness in limbs as the major symptoms. By contrast, 2 female patients suffered from acute onset of symptoms, presenting with headache and seizures. Brain computed tomography and magnetic resonance imaging showed large hemorrhagic lesions surrounded by massive edemas in the 4 patients. Brain biopsies were performed in the 4 patients due to concern for brain tumors. However, the pathological results supported the diagnosis of ICoVT, and the subsequent anticoagulant treatment administered was effective for all 4 patients. In conclusion, ICoVT can be easily misdiagnosed as brain tumor because of the atypical clinical and imaging features. The results suggested that the possibility of ICoVT always be considered in patients with neuroimaging showing cortical hemorrhagic lesions with massive edemas.

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

“…Even though the initial read on imaging was highly suspicious for PML especially given the patient’s higher risk for HIV infection, overall the aetiologies outside of our final diagnosis of ICVT were thought to be very unlikely, due to the lack of progressive symptoms, the absence of immunosuppression, the grossly normal laboratory tests, the reassuring findings on lumbar puncture and the marked resolution on follow-up MRI. ICVT is known to mimic other neurological conditions radiographically,3 4 but to our current knowledge, we believe that this is the first case report demonstrating ICVT mimicking PML. This is an important finding, as the former disease has a good outcome, while the latter is rapidly progressive and fatal.…”

“…It frequently involves anastomotic surface vessels such as the vein of Trolard, the vein of Labbé, the superficial Sylvian vein and the precentral, postcentral and central veins. It has been known to mimic other conditions on MRI, such as subarachnoid haemorrhage, transient ischaemic attack3 or even brain tumour 4. ICVT has subtle findings on CT, occasionally presenting with hyperdense vein sign within 7-14 days,5 but frequently found to be normal.…”

Acute cerebral venous thrombosis – still underdiagnosed pathology in the emergency computed tomography of the brain

“…Other studies also reported that lesions due to CVT were misinterpreted; for example, thrombosed cortical veins as a subarachnoid haemorrhage or a subdural haematoma, focal brain haemorrhage as haemorrhagic contusions, and focal oedema or haemorrhage as brain tumours [ 11 ]. The authors concluded that it is essential to always correlate imaging findings with the clinical context and to look for other lesions, especially within dural sinuses and veins [ 12 ]. It must be stressed that haemorrhagic lesions are fairly typical for venous infarctions, and because the thrombosis of the superficial system is more common than the deep venous system they are usually located within the cortex or at the grey-white matter junction, as in our cases.…”

Radiologische Hinweise auf zerebrale Venenthrombose

“…Ein fokales Ödem oder eine fokale Blutung kann auch als Hirntumor fehlinterpretiert werden. Es ist wichtig, die Signalintensität der umliegenden kortikalen Venen zu beurteilen [78]. In den letzten Jahrzehnten ist die ZVT-assoziierte Mortalität erheblich zurückgegangen: Die berichteten Mortalitätsraten liegen in einem Bereich von 0 -39 % [16,66,80,81].…”