The "cord sign" in cerebral venous thrombosis associated with high plasma levels of factor VIII

Abstract

Background: Cerebral venous thrombosis (CVT) is a potentially life-threatening condition that requires acute recognition and treatment. Diagnosis of CVT is challenging and requires a high index of clinical suspicion. The finding of the "cord sign" in a non-contrast cranial CT is useful for the rapid recognition of CVT in the emergency setting.

Methods: We describe a patient with CVT in whom the "cord sign" and elevated factor VIII (FVIII) plasma levels were both present.

Results: A 45-year-old Caucasian man was brought to the emergency room with headache and a focal seizure. His neurological examination was non-focal. During his evaluation in the ER, a non-contrast cranial CT showed increased density of cortical veins ("cord sign"), vein of Galen, and superior sagittal, transverse and straight sinuses. A brain MRI demonstrated a flow signal void in the superior sagittal sinus, prominent cortical veins, asymmetric flow signal in the right transverse sinus, and subarachnoid hemorrhage adjacent to the superior sagittal sinus. Laboratory work-up was unremarkable and only revealed elevation of FVIII plasma levels.

Conclusions: We report the first case of CVT with the "cord sign" and concomitant elevated FVIII. Early recognition of the "cord sign" is warranted for the emergency diagnosis and treatment of CVT.