THE STROKE SYNDROME OF CORTICAL VEIN-THROMBOSIS

Cortical vein thrombosis without sinus involvement is rarely diagnosed , although it may commonly be overlooked. We report four cases of cere bral venous thrombosis limited to the cortical veins. The diagnosis wa s made on surgical intervention in one patient and by angiography in t hree patients. Together with a survey of the published cases, the clin ical and neuroimaging patterns of our patients allow delineation of se veral features suggestive of cortical venous stroke. Focal or generali zed seizures followed by hemiparesis, aphasia, hemianopia, or other fo cal neurologic dysfunction in the absence of signs of increased intrac ranial pressure should suggest this possibility. Neuroimaging (CT, MRI ) shows an ischemic lesion that does not follow the boundary of arteri al territories and often has a hemorrhagic component, without signs of venous sinus thrombosis. Conventional angiography demonstrates no art erial occlusion but may show cortical vein thrombosis corresponding to the infarct, although these may also be nonspecific findings. The rol e of MR angiography, which is well-established in sinus thrombosis, re mains to be assessed in patients with brain ischemia due to isolated c ortical vein occlusion.