title: Atypical clinical and pathological findings in a patient with isolated cortical vein thrombosis.
abstract: Isolated cortical vein thrombosis often produces a focal lesion. Because of the rapid development of collateral circulation, increased intracranial pressure has never been reported in a patient with isolated cortical vein thrombosis. The diagnosis of isolated cortical vein thrombosis is based mainly on MRI, catheter digital subtraction angiography, and histological findings, but may be challenging. We report a patient who presented with intermittent seizures and left-sided limb weakness. Her symptoms gradually progressed, and she eventually developed signs of increased intracranial pressure. Imaging studies showed a space-occupying lesion in the right frontal lobe of the brain. As we could not diagnose isolated cortical vein thrombosis based on the preoperative findings, surgical excision of the lesion was performed under general anesthesia. Histological examination showed destruction of the brain parenchyma with infiltration of macrophages, proliferation of reactive astrocytes and small vessels, and foci of hemorrhage. Further examination found that a number of small vessels in both the subarachnoid space and brain parenchyma were filled with thrombus, some of which was organized. Elastic fiber staining showed that the obstructed vessels were veins. We diagnosed isolated cortical vein thrombosis with atypical clinical features.
authors.affiliation: Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA.
authors.forename: Vance
authors.initials: V
authors.lastname: Fredrickson
authors.affiliation: Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Yicong
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Yueshan
authors.initials: Y
authors.lastname: Piao
authors.affiliation: Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Xiangbo
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Dehong
authors.initials: D
authors.lastname: Lu
authors.affiliation: Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
authors.forename: Cunjiang
authors.initials: C
authors.lastname: Li
keywords: CT; MRI; cortical vein; edema; epilepsy; hemiplegia; hemorrhage; increased intracranial pressure; infarction; neural regeneration; neuroimaging; pathology; thrombosis