0:01

Well, if superior sagittal sinus or transverse

0:04

sinus thrombosis is not subtle enough to identify,

0:09

a cortical venous thrombosis is even more subtle.

0:14

And what you're looking for are veins that

0:17

are leading towards the superior sagittal

0:20

sinus or transverse sinus that are too dense.

0:23

This happens to be a Grade A,

0:27

very obvious case, but here we have a patient

0:31

who had a new neurologic deficit.

0:33

In this case, it was left-sided hemiparesis.

0:38

And on the CT scan, we saw this low-density area

0:42

in the perirolandic motor area on the right side.

0:49

But in addition, we noticed that there

0:52

were some bright blood vessels that were

0:55

leading towards the superior sagittal sinus.

0:58

So these bright blood vessels coming from the

1:01

periphery would be our cortical vein thrombosis.

1:06

This would probably be better demonstrated

1:09

on the thinnest section imaging.

1:11

And if I scroll all the way up and window appropriately,

1:16

you can see those hyperdense veins coming together

1:22

and then joining the superior sagittal sinus.

1:25

So the sinus itself was not thrombosed,

1:27

but the peripheral veins were thrombosed,

1:30

leading to this patient's area of abnormal density.

1:36

When we look at the accompanying MRI scan,

1:41

which actually was performed after the CT,

1:46

what you see is the edema of the affected

1:52

tissue along the motor strip region.

1:56

This is the motor strip coming

1:57

along here in this patient.

2:02

And there is that amount of edema.

2:05

Venous infarctions have a high

2:07

rate of potential hemorrhage.

2:11

So on the susceptibility-weighted and gradient

2:14

echo scan, you may see blood products here.

2:17

What we're also seeing is the

2:19

clot in that superficial vein.

2:22

So this is a dilated vein filled with black clot,

2:28

acute clot, as well as parenchymal hemorrhage

2:33

in the area of venous injury.

2:35

Curiously enough, when we make a move to

2:39

the diffusion-weighted imaging, this is

2:43

the ADC map, you don't see all that much.

2:47

And that's one of the things about venous infarctions,

2:49

they can have a very confusing appearance on the DWI.

2:54

Largely because not only do they cause cytotoxic

2:58

edema, but because of the venous obstruction,

3:01

they also cause vasogenic edema in the outflow.

3:06

The MR venograms are going to be hard to

3:09

interpret because we're looking at not the sinus,

3:11

which is the easiest part, but those vessels

3:14

leading to the sinuses that will be thrombosed.

3:18

In this case, assuming everything is symmetrical,

3:22

we see the normal draining veins on the left side

3:25

and the missing draining vein on the right side.

Case: Cortical Vein Thrombosis on CT, MRI, MRV

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