Cortical Venous Thrombosis Caused by Venous Compression by Arachnoid Cyst

Abstract

Clinical problem: Identification, work-up and treatment approach of isolated cortical venous thrombosis (ICVT) in the absence of traditional risk factors.

Case presentation: A 66-year-old previously well male presenting with two episodes of left-sided spreading sensory symptoms, found to be secondary to ICVT from extrinsic compression by an arachnoid cyst.

Key teaching points: Early identification of structural abnormalities causing extrinsic venous compression and ICVT or cerebral venous sinus thrombosis (CVST) is important for alternative treatment options and to avoid unnecessary testing.

Keywords: anatomic imaging; arachnoid cyst; cerebral angiography; cortical venous thrombosis; stroke.

Figure 1.

(A) Axial and (B) coronal multiphase CT angiogram demonstrating isolated cortical vein thrombosis (ICVT) overlying the right parietal lobe. (C) Non-contrast CT scan showing mild subarachnoid hemorrhage in the right posterior parietal region. (D) Cerebral angiogram demonstrating stenosis of the right vein of Trolard at the insertion to the superior sagittal sinus, and right hemisphere venous dilation. (E) Sagittal and (F) axial MRI T2 sequence scans demonstrating the hyperintense right parasagittal vertex arachnoid cyst causing compression at the cortical vein insertion.