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Atypical clinical and pathological findings in a patient with isolated cortical vein thrombosis

Neural Regeneration Research 2012年第31期7卷 2473-2479页

作者： Yan Ding vance fredrickson Yicong Lin Yueshan Piao Xiangbo Wang Dehong Lu Cunjiang Li Department of Neurology Xuan wu Hospital Capital Medical University Beijing 100053 China Department of Neurological Surgery Wayne State University School of Medicine Detroit M148201 USA Department of Pathology Xuanwu Hospital Capital Medical University Beijing 100053 China

Isolated cortical vein thrombosis often produces a focal lesion. Because of the rapid development of collateral circulation, increased intracranial pressure has never been reported in a patient with isolated cortical vein thrombosis. The diagnosis of isolated cortical vein thrombosis is based mainly on MRI, catheter digital subtraction angiography, and histological findings, but may be challenging. We report a patient who presented with intermittent seizures and left-sided limb weakness. Her symptoms gradually progressed, and she eventually developed signs of increased intracranial pressure. Imaging studies showed a space-occupying lesion in the right frontal lobe of the brain. As we could not diagnose isolated cortical vein thrombosis based on the preoperative findings, surgical excision of the lesion was performed under general anesthesia. Histological examination showed destruction of the brain parenchyma with infiltration of macrophages, proliferation of reactive astrocytes and small vessels, and foci of hemorrhage. Further examination found that a number of small vessels in both the subarachnoid space and brain parenchyma were filled with thrombus, some of which was organized. Elastic fiber staining showed that the obstructed vessels were veins. We diagnosed isolated cortical vein thrombosis with atypical clinical features.

关键词： thrombosis cortical vein pathology infarction hemorrhage epilepsy hemiplegia edema increased intracranial pressure MRI CT neuroimaging neural regeneration

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