Serial Neuroimaging of a Patient with Minor Stroke due to Isolated Cortical Vein Thrombosis and Convexal Subarachnoid Hemorrhage

Abstract

Purpose: Convexal subarachnoid hemorrhage (cSAH) comprises less than 5% of cases of nontraumatic SAH and frequently presents as a focal and transient neurological deficits that mimics transient ischemic attack (TIA). Isolated cortical vein thrombosis (ICVT) is rare and accounts for only 6.3% of cerebral venous thrombosis. We present a case of minor stroke due to cSAH secondary to ICVT, and alos put emphasis on the chronological change of those serial imagings.

Case report: An 87-year-old man presented with episodes of numbness and dropping of his left arm, which had lasted for three days. Brain computed tomography disclosed a cSAH in the right frontoparietal region. Brain magnetic resonance (MR) study showed a cSAH in the right fronto-parietal sulci. Focal swelling of the right frontal cortex with an intraluminal filling defect in the right cortical vein and venous congestion were observed using post-contrast T1-weighted images, suggesting partial thrombosis with recanalization of the cortical vein but a patent superior sagittal sinus. Diffuse linear superficial cortical hemosiderosis (SCH) was detected in the right anterior frontal cortex, right fronto-parietal cortex and left high frontal cortex. He spontaneously recovered from his minor neurological deficits within two weeks. A follow-up MR study three weeks later found a hyperintense cord sign indicating a cSAH in the right high central sulcus on fluid-attenuated inversion recovery and T2-weighted images. A further follow-up MR study two months later showed gradual shrinkage of the cSAH with persistent diffuse SCH.

Conclusion: This case report clearly showed chronological change of brain MRI and head CT findings. MR studies help in recognizing the occurrence of acute and chronic cSAHs, and ICVT.