Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Neural Regen Res. 2012 Nov 5;7(31):2473-9. doi: 10.3969/j.issn.1673-5374.2012.31.009.
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.
孤立性皮质静脉血栓形成常引起局灶性病变。由于侧支循环迅速发展，孤立性皮质静脉血栓形成患者从未出现过颅内压增高的情况。孤立性皮质静脉血栓形成的诊断主要基于 MRI、导管数字减影血管造影和组织学发现，但可能具有挑战性。我们报告了一例以间歇性癫痫发作和左侧肢体无力为表现的患者。她的症状逐渐进展，最终出现颅内压增高的体征。影像学检查显示右额叶有占位性病变。由于我们无法根据术前检查结果诊断孤立性皮质静脉血栓形成，因此在全身麻醉下对病变进行了切除。组织学检查显示脑实质破坏，有巨噬细胞浸润、反应性星形胶质细胞和小血管增生以及出血灶。进一步检查发现蛛网膜下腔和脑实质内的许多小血管都充满了血栓，其中一些已经机化。弹力纤维染色显示阻塞的血管为静脉。我们诊断为具有非典型临床表现的孤立性皮质静脉血栓形成。
