RESIDENT
& FELLOW
SECTION
Section Editor
Mitchell S.V. Elkind,
MD, MS

Slaven Pikija, MD
Peter Unterkreuter, MD
Michael Knoflach, MD

Teaching NeuroImages:
Magnetic resonance susceptibility effect
for acute isolated cortical vein thrombosis
Figure 1

Baseline noncontrast CT scan

Correspondence to
Dr. Pikija:
spikija@gmail.com

Axial CT scan shows subtle hemorrhagic infarction in left parietal region (white arrow; A) with associated hyperdense
cortical vein (black arrow; B).

Figure 2

MRI susceptibility-weighted imaging 15 hours after onset

Axial MRI with susceptibility-weighted imaging shows magnetic susceptibility effect in left parietal area (A) and ipsilateral
cortical vein (arrow; B). MRI time-of-flight venography was negative (not shown).

A 38-year-old woman using hormonal contraception
presented with right-sided abdominal and arm clonic
seizures, right hemiparesis, hypesthesia, and nausea.
She denied headache. D-dimers were 350 ng/mL
(laboratory reference #500 ng/mL). CT showed a
small left parietal hemorrhagic infarct with adjacent
hyperdense cortical vein (figure 1). MRI 15 hours

after onset showed magnetic susceptibility effect on
susceptibility-weighted imaging (SWI, figure 2). Isolated cortical vein thrombosis is present in 5% of
patients with cerebral venous thrombosis (CVT).1
Negative D-dimer and absence of headache does
not exclude CVT1 and SWI is useful for confirmation
of the diagnosis.2

Download teaching slides:
Neurology.org
From the Department of Neurology (S.P., P.U.), Bezirkskrankenhaus Lienz; and the Department of Neurology (M.K.), Innsbruck Medical
University, Austria.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
e178

© 2014 American Academy of Neurology

ª 2014 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.

AUTHOR CONTRIBUTIONS

DISCLOSURE

Slaven Pikija: drafting/revising the manuscript, study concept or design,
analysis or interpretation of data, accepts responsibility for conduct of
research and final approval, contribution of vital reagents/tools/patients,
acquisition of data, study supervision. Peter Unterkreuter: drafting/revising the manuscript, accepts responsibility for conduct of research and
final approval, contribution of vital reagents/tools/patients, acquisition
of data. Michael Knoflach: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility
for conduct of research and final approval, study supervision.

The authors report no disclosures relevant to the manuscript. Go to
Neurology.org for full disclosures.

STUDY FUNDING
No targeted funding reported.

REFERENCES
1. Boukobza M, Crassard I, Bousser MG, et al. MR imaging
features of isolated cortical vein thrombosis: diagnosis
and follow-up. AJNR Am J Neuroradiol 2009;30:
344–348.
2. Idbaih A, Boukobza M, Crassard I, et al. MRI of clot in
cerebral venous thrombosis: high diagnostic value of
susceptibility-weighted images. Stroke 2006;37:991–995.

Neurology 83

November 11, 2014

e179

ª 2014 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.

Teaching NeuroImages: Magnetic resonance susceptibility effect for acute isolated
cortical vein thrombosis
Slaven Pikija, Peter Unterkreuter and Michael Knoflach
Neurology 2014;83;e178-e179
DOI 10.1212/WNL.0000000000000988
This information is current as of November 10, 2014
Updated Information &
Services

including high resolution figures, can be found at:
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Supplementary Material

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http://www.neurology.org/content/suppl/2014/11/08/WNL.000000000
0000988.DC1.html

References

This article cites 2 articles, 2 of which you can access for free at:
http://www.neurology.org/content/83/20/e178.full.html##ref-list-1

Subspecialty Collections

This article, along with others on similar topics, appears in the
following collection(s):
All Cerebrovascular disease/Stroke
http://www.neurology.org//cgi/collection/all_cerebrovascular_disease_
stroke
All Epilepsy/Seizures
http://www.neurology.org//cgi/collection/all_epilepsy_seizures
Stroke in young adults
http://www.neurology.org//cgi/collection/stroke_in_young_adults

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