Showing posts with label Isolated thrombosis of cortical veins. Show all posts
Showing posts with label Isolated thrombosis of cortical veins. Show all posts

Sunday, 11 March 2012

Vein of Labbe MR Venogram Brain

Named after 17th century French surgeon Charles Labbé who described it in his 3rd year of medical school.
The vein is a part of the superficial venous system of the brain, crosses the temporal lobe from sylvian fissure to end in ipsilateral lateral sinus mostly at the junction of transverse and sigmoid sinus. Exact location in temporal region is variable may be anterior temporal, middle temporal or posterior temporal of which middle temporal is most common. The structural anatomy of the vein itself is also variable, with a dominant single channel, multiple branching channels and even venous lakes having been described.

Vein of Labbé is also known as Inferior anastomotic vein, connects the superficial middle cerebral vein of Sylvius from sylvinan fissure to the lateral sinus.
Also important know here about Vein of Trolard, also known as superior anastomotic vein, often located in post central sulcus, connects the superficial middle cerebral vein of Sylvias from sylvian fissure to the superior sagittal sinus.
The dominance of these anastomotic veins is dictated by the relative size of the superficial middle cerebral vein and the other anastomotic vein. There is inverse relationship between the size of the superficial middle cerebral vein, the anastomotic vein of Trolard and the vein of Labbé, as all three shares a common drainage area. 

Clinical significance:
Surgery : Important to know about the vein and to preserve the vein during Temporal lobectomy for temporal lobe epilepsy or Decompressive craniecotmy.
Thrombosis : isolated thrombosis of this vein is known where MR Venogram may show controversial findings like normal or congenital absent ipsilateral lateral sinus with a hemorrhagic venous infarct which may be otherwise mistaken for hemorrhagic contusion. 

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.