title: Ipsilateral Dural Thickening and Enhancement: A Sign of Isolated Cortical Vein Thrombosis? A Case Report and Review of the Literature.
abstract: BACKGROUND
  Isolated cortical vein thrombosis (ICVT) being a rare condition (6% of intracranial vein thromboses), no clinical guidelines and few radiologic clues to it have been established. ICVT mostly appears in conjunction with sinus vein thromboses. ICVTs primarily occur during pregnancy and puerperium (35%). The great variability of cortical veins and difficulty identifying small occluded vessels complicate ICVT diagnosis. We present the first case of isolated ipsilateral dural thickening and enhancement as a potential radiologic sign of ICVT shown on magnetic resonance imaging.
  
  
  METHODS
  A 30-year-old woman presented with sudden position-independent severe headache and neck pain 2 weeks postpartum. Standard magnetic resonance imaging revealed ipsilateral dural thickening and enhancement of the meninges (left hemisphere). The symptoms and findings were interpreted as a post-lumbar puncture syndrome associated with the epidural anesthesia during labor and birth. Deteriorating, the patient was referred to our hospital after a computed tomography scan had revealed atypical left parietal intracranial hemorrhage. Digital cerebral subtraction angiography confirmed a left parietal ICVT as the underlying disease. When systemic anticoagulation was initiated, the patient's condition further deteriorated. Progressive aphasia and right-sided face and arm weakness and numbness developed as a result of increased intracranial hemorrhage volume. We therefore performed craniotomy and hematoma evacuation, after which the patient fully recovered.
  
  
  CONCLUSIONS
  We hypothesize that ipsilateral dural thickening and enhancement in patients presenting with severe headache may indicate ICVT and we suggest further diagnostic workup, using venographic study such as computed tomographic venography or magnetic resonance venography. In an inconclusive venographic study with high clinical suspicion for ICVT, catheter cerebral angiography is indicated.
authors.affiliation: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland. Electronic address: neurosurgery@ksa.ch.
authors.forename: Davide Marco
authors.initials: DM
authors.lastname: Croci
authors.affiliation: Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Diepers
authors.initials: D
authors.lastname: Michael
authors.affiliation: Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Timo
authors.initials: T
authors.lastname: Kahles
authors.affiliation: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Ali-Reza
authors.initials: AR
authors.lastname: Fathi
authors.affiliation: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Javier
authors.initials: J
authors.lastname: Fandino
authors.affiliation: Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Serge
authors.initials: S
authors.lastname: Marbacher
mesh_terms: D000328:Adult; D004388:Dura Mater / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000473:pathology*
keywords: Ipsilateral dural thickening; Isolated cortical vein thrombosis; Magnetic resonance imaging