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The stroke syndrome of cortical vein thrombosis

From the Departments of Neurology (Drs. Jacobs and Dehaene) and Radiology (Dr. Casselman), Algemeen Ziekenhuis St.-Jan, Brugge, Belgium; the Department of Neurology (Drs. Moulin and Tatu), Centre Hospitalier Universitaire Jean Minjoz, Besancon, France; the Department of Neurology (Drs. Bogousslavsky and Besson), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; and the Departments of Neurology (Dr. Woimant) and Radiology (Dr. Assouline), Hopital Lariboisiere, Paris, France.
Received November 6, 1995. Accepted in final form February 2, 1996.
Address correspondence and reprint requests to Dr. Julien Bogousslavsky, Department of Neurology CHUV, CH-1011 Lausanne, Switzerland.

Cortical vein thrombosis without sinus involvement is rarely diagnosed, although it may commonly be overlooked.We report four cases of cerebral venous thrombosis limited to the cortical veins. The diagnosis was made on surgical intervention in one patient and by angiography in three patients. Together with a survey of the published cases, the clinical and neuroimaging patterns of our patients allow delineation of several features suggestive of cortical venous stroke. Focal or generalized seizures followed by hemiparesis, aphasia, hemianopia, or other focal neurologic dysfunction in the absence of signs of increased intracranial pressure should suggest this possibility. Neuroimaging (CT, MRI) shows an ischemic lesion that does not follow the boundary of arterial territories and often has a hemorrhagic component, without signs of venous sinus thrombosis. Conventional angiography demonstrates no arterial occlusion but may show cortical vein thrombosis corresponding to the infarct, although these may also be nonspecific findings. The role of MR angiography, which is well-established in sinus thrombosis, remains to be assessed in patients with brain ischemia due to isolated cortical vein occlusion.

NEUROLOGY 1996;47: 376-382

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