Thursday 25 August 2011

Isolated cortical vein thrombosis MRI Brain

A 50 yo male with mild vertex headache. 
Here is his MRI Brain Axial FLAIR, T2 *GRE and non contrast 2 D TOF MR Venogram of Brain. 

This MRI study of Brain shows:
A focal vasogenic oedema in right parietal sub cortical white matter on FLAIR.
T2*GRE images show serpigenous thin cord like low signal intensities in right para sagittal parietal cortical sulci seems to be the thrombosed cortical veins. Adjacent superior sagittal sinus show normal flow voids and flow related signals on MR Venogram being not thrombosed yet. A focal flow loss of superior sagittal sinus near torcula  is artifactual due to inflow imaging.

Impression: Isolated cortical vein thrombosis. 

Terms cortical vein thrombosis and dural sinus venous thrombosis are used alternately and most of the time collectively called CVT.
They are different terms, though both are related to each and may be present simultaneously. But there can be isolated cortical vein thrombosis. Dural venous sinuse may be normal, particularly the superior sagittal sinus not yet thrombosed as in this case.

Pt was put on anticaugulants.
This is his follow up study.
The low signal intensity of thrombosed cortical veins on T2*GRE images , right parietal focal vasogenic odema has completely regressed.

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