Isolated cortical vein thrombosis: case series

Singh, Ranjodh; Cope, William P.; Zhou, Zhiping; Witt, Michelle E. De; Boockvar, John A.; Tsiouris, Apostolos John

doi:10.3171/2014.9.jns141813

Cited by 33 publications

(30 citation statements)

References 48 publications

(54 reference statements)

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“…We also integrated multiple imaging techniques for the detection of CV thrombosis. According to a recent study (14), SWI is useful for the detection of CV thrombosis. In the present study, SWI was obtained in 20 patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…Isolated cortical vein thrombosis (ICVT) is rare, accounting for less than 1% of all cerebral infarctions. 4 Hemorrhagic stroke in children includes spontaneous intracerebral hemorrhage with or without intraventricular extension, intraventricular hemorrhage (IVH), and nontraumatic subarachnoid hemorrhage.…”

Section: Pediatric Stroke Classificationmentioning

confidence: 99%

“…Case series of ICVT report a "cord sign" or "dot sign" on CT in 13% to 51% 4 (Fig 8). On CT, high hemoglobin concentration in the setting of dehydration or polycythemia can also be confused with clot, but in these individuals the entire vascular system is dense.…”

Section: Csvt and Cortical Vein Thrombosismentioning

confidence: 99%

“…In one case series, SWI was 90% sensitive for detecting CSVT and 97% sensitive for ICVT within the first week of clinical onset compared with T1SE (71 and 78% sensitive, respectively). 4 Three-dimensional volumetric GRE T1-weighted sequences do not suffer from the artifacts that may plague T1SE and are quite adept at demonstrating clot, particularly after the administration of contrast (Fig 8). DWI hyperintensity within the thrombosed sinus has also been described but has poor sensitivity.…”

Section: Csvt and Cortical Vein Thrombosismentioning

confidence: 99%

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Pathways for Neuroimaging of Childhood Stroke

Mirsky

Beslow

Amlie‐Lefond

et al. 2017

Pediatric Neurology

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“…Diagnosis, classification, and imaging evaluation. The diagnosis of CVST was suspected from the clinical presentation and confirmed with computed tomography venography (CTV) and magnetic resonance venography (MRV) that demonstrated absence of flow in a venous sinus/cortical vein and intraluminal venous thrombus 2,3,10,11 . The authors classified the configurations of CVST into four types for the ease of discussion ( Fig.…”

mentioning

confidence: 99%

Endovascular Mechanical Thrombectomy and On-Site Chemical Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

Liao

Chen

et al. 2020

Sci Rep

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chen 5,11 , Hung-Chieh chen 5,6 , chiung-chyi Shen 2,7,9,10* , Shun-Fa Yang 1,8* & Yuang-Seng tsuei 1,2,7* cerebral venous sinus thrombosis (cVSt) is a rare cause of cerebral infarction. once patients survive the acute phase, long-term prognosis is generally satisfactory. CVST patients who harbored risk factors known for poor prognosis (e.g., deterioration of consciousness/neurological functions and seizures) were oftentimes unresponsive to systemic heparin treatment. The advantage of combined endovascular mechanical thrombectomy (eMt) and on-site chemical thrombolysis (oct) plus systemic heparin for CVST over the heparin treatment alone has not been proved. A retrospective study was conducted to analyze consecutive patients with CVST from 2005 to 2015. Patients having clinical improvement or stable disease after heparin treatment were in I/S group; patients having continuous deterioration of consciousness/neurological functions and refractory seizures (despite the use of multiple anti-epileptic drugs) after heparin treatment were in D group. EMT and OCT were indicated for patients in D group. Imaging studies and medical records were reviewed for statistical analysis. Safety issues included new-onset/progression of symptomatic intracerebral hemorrhages (ICH) or procedurerelated complications. Total thirty patients were included (I/S group = 16; D group = 14). In D group, the mean time frame from the start of heparin treatment to the endovascular treatment was 3.2 days. Compared with I/S group, all patients in D group had complete stenosis of the sinuses, with higher initial mRS, lower initial GCS, and more seizures (p = 0.006, 0.007, and 0.031, respectively), but no significant differences in the mRS at discharge (p = 0.504). Shorter length of thrombosis and lower initial mRS were associated with better outcomes (p = 0.009 and 0.003, respectively). Thrombosis involving the superior sagittal sinus (SSS) was associated with bad outcomes (p = 0.026). There were two patients (6.7%) with worsening symptomatic ICH, one in each group, managed surgically. The overall mortality of the study was 6.7% (2/30). Combined EMT and OCT after heparin treatment for severe CVST were reasonably safe, which might be considered as a salvage treatment in severe CVST patients who are unresponsive to heparin with heavy clot burden involving SSS in the acute phase. However, further studies are needed to confirm its efficacy and validity. Cerebral venous sinus thrombosis (CVST) is a rare disease. The diagnosis could easily be missed if the initial presentation is non-specific headaches. Heparin (unfractionated heparin or low-molecular-weight heparin) is the first-line treatment. Concomitant intracerebral hemorrhage related to CVST is not a contraindication to heparin

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Isolated cortical vein thrombosis: case series

Cited by 33 publications

References 48 publications

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

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

Pathways for Neuroimaging of Childhood Stroke

Endovascular Mechanical Thrombectomy and On-Site Chemical Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

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