Cortical vein thrombosis with infarct and hemorrhage

Case contributed by Dr James Harvey

Presentation

Child presenting to the emergency department with first seizure.

Patient Data

Age: 10 years
Gender: Male
CT

Non-contrast CT head

Distended and hyperdense left sided superficial cortical vein (of Trolard) with a further focus of hyperdensity within the superior sagittal sinus.
Ill-defined wedge shaped focus of hypodensity seen within the high left parietal lobe with associated small focus of parenchymal hemorrhage. 

Findings represent a left-sided superficial cortical vein thrombosis with focal extension of thrombus into the superior sagittal sinus and associated left high parietal hemorrhagic venous infarction. No associated mass effect or midline shift.

Annotated image

Annotated CT head

Expanded, hyperdense left vein of Trolard.

The left vein of Trolard is non-opacified through its course.  A 2 cm non-occlusive filling defect is present within the superior sagittal sinus.

An ovoid area of T2 and FLAIR hyperintensity is present within the left anterior parietal and posterior frontal lobe. This region demonstrates large areas of diffusion restriction, with associated susceptibility artefact on SWI, in keeping with intraparenchymal hemorrhage.

The area of diffusion restriction and SWI artefact involves the post-central gyrus laterally. T2 and FLAIR hyperintensity, in keeping with edema, extends into the precentral gyrus. 
Mild mass effect is exerted on the adjacent parenchyma, with effacement of the superior parietal sulci.
Thin, continuous cortical enhancement is evident.

No significant rightward midline shift.

Case Discussion

The superior anastamotic veins (veins of Trolard) are the largest paired superficial veins draining to the superior sagittal sinus.

The unenhanced CT in this case nicely demonstrates the cord sign of a hyperdense, expanded cerebral vein.

Anticoagulation is the mainstay of treatment.

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Case information

rID: 80380
Published: 23rd Jul 2020
Last edited: 3rd Aug 2020
Inclusion in quiz mode: Included

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