Clinical and Radiological Manifestations of Cerebral Venous Thrombosis: Are There Any Differences According to Presence or Absence of Cortical Vein Involvement?

Abstract

Background: Cerebral venous thrombosis (CVT) is difficult to diagnose because of the variety of its clinical and imaging findings and the many anatomical variations in the cerebral venous system. Objectives: We aimed to investigate the clinical and radiological CVT and to evaluate differences in their findings, according to the presence or absence of cortical vein involvement (CVI). Patients and Methods: From the 13 years database of our institution, forty-nine patients were enrolled in the study. In all patients, CVT was confirmed on CT venography, MR venography and/or digital subtraction angiography (DSA). We retrospectively reviewed the clinical presentations and CT and MR findings of the patients and compared their findings, according to the presence or absence of CVI. Results: CVI was detected in 31 patients (63.3%). The most common clinical symptom was headache (61.2%), followed by focal neurologic deficit (FND) (49.0%), seizure (40.8%), and altered consciousness (18.4%). FND was frequent in the CVI group (67.7 vs. 16.7%, P = .001). On CT (n = 49) and/or MR (n = 38), intracranial hemorrhage was present in 33 patients (67.3%) and parenchymal hyperintensity was detected in 24/38 (63.2%). Subarachnoid hemorrhage (SAH) was frequent in the CVI group (51.6 vs. 16.7%, P = .018). The cortical vein (CV) was the most common site of CVT (63.3%), followed by superior sagittal (61.2%), transverse (53.1%), sigmoid (42.9%), and straight (20.4%) sinuses. The superior sagittal sinus thrombosis was frequently associated with concomitant CV thrombosis (74.2 vs. 38.9%, P = .032). Conclusion: CVT commonly involved the CV. Although its clinical manifestation was diverse, FND was common in the CVI group. Intracranial hemorrhage and parenchymal hyperintensity were common CT and MR findings and SAH was commonly associated in the CVI group.

A Case-Based Review of Cerebral Venous Infarcts With Perfusion Imaging and Comparison to Arterial Ischemic Stroke

“…Superficial/cortical vein thrombosis appears as hyperdense cortical vessels on NECT, or the “cord sign.” Isolated cortical vein thrombosis has been considered rare (up to 5%) ( 7 ). In a retrospective analysis of 49 patients, Jang et al noted cortical veins as the most common site of CVT at 63%, followed by SSS at 61%, which may relate to SSS thrombosis as a frequent concomitant finding along with cortical vein thrombosis ( 7 , 12 ). SSS occlusion with extension to the cortical veins may present with edema and petechial hemorrhage with involvement of the cortex and subcortical white matter, as well as subarachnoid hemorrhage along the convexity ( 7 ).…”

“…Another group found that the most recent patterns of parenchymal abnormalities in 44 consecutive patients hospitalized with CVT were HI (56.8%), ICH (22.72%), and NHI (20.45%) ( 9 ). Multiple other studies have addressed the anatomic distribution of CVI by frequency ( 1 , 2 , 4 , 5 , 12 ). Although most cases of sinus thrombosis involve multiple sinuses, the superior sagittal sinus (SSS) is the most common site of dural sinus thrombosis followed by the transverse sinus (TS) and sigmoid sinus (SS) ( 1 , 4 , 5 ).…”

“…Superficial/cortical venous thrombosis, particularly when isolated, was the most uncommon site of CVT ( 5 ). SSS thrombosis is often associated with concurrent cortical vein thrombosis ( 12 ).…”