Classic Case

Cortical vein thrombosis involves superficial cerebral veins and is often associated with deep cerebral vein thrombosis or dural venous sinus thrombosis. Isolated cortical venous thrombosis is only rare and has a variable clinical presentation, ranging from no symptoms to headache or seizure. Risk factors include hormone imbalance (contraceptive), infection (meningitis, mastoiditis), malignancy, connective tissue disorders, and prothrombotic hematologic conditions. The thrombosed cortical vein may appear as a dense vein sign on CT, while MRI discloses a hyperintense signal on T2WI (A, red arrow) and DWI (B, red arrow). The thrombus appears hypointense on T2*-weighted imaging (C, green arrow). The cord sign can be visible on FLAIR, which reflects thrombosis along the cortical vein (D, blue arrows). A parietal subcortical "roundish" white matter edema is a classic feature associated with cortical vein thrombosis (A and D, yellow arrows). This edema corresponds with vasogenic edema with increased water diffusion (B), which may progress to cytotoxic edema. Unlike arterial infarction, cerebral venous infarction appears after days of evolution. The mainstay of treatment is heparin therapy.