Abstract
Cerebral cortical vein thrombosis (CCVT) is often misdiagnosed because of its non-specific diagnostic symptoms. Here, we analyzed a cohort of patients with CCVT in hopes of improving understandings and treatments of the disease. A total of 23 patients with CCVT (confirmed with high-resolution imaging), who had been diagnosed between 2017 and 2019, were enrolled in this cohort study. Baseline demographics, clinical manifestations, laboratory data, radiological findings, treatment, and outcomes were collected and analyzed. Fourteen females and nine males were enrolled (mean age: 32.7 ± 11.9 years), presenting in the acute (within 7 days, n = 9), subacute (8–30 days, n = 7), and chronic (over 1 month, n = 7) stages. Headaches (65.2%) and seizures (39.1%) were the most common symptoms. Abnormally elevated plasma D-dimers were observed in the majority of acute stage patients (87.5%). The diagnostic accuracy of contrast-enhanced magnetic resonance venography (CE-MRV) and high-resolution magnetic resonance black-blood thrombus imaging (HR-MRBTI) in detecting CCVT were 57.1 and 100.0%, respectively. All patients had good functional outcomes after 6-month of standard anticoagulation (mRS 0–1) treatment. However, four CCVT patients that had cases involving multiple veins showed symptom relief after batroxobin therapy (p = 0.030). HR-MRBTI may be a fast and accurate tool for non-invasive CCVT diagnosis. HR-MRBTI combined with D-dimer can also precisely identify the pathological stage of CCVT. Batroxobin may safely accelerate cortical venous recanalization in combination with anticoagulation. Follow-up studies with larger sample sizes are suggested to evaluate the safety and efficacy of batroxobin for treating CCVT.
Highlights
Cerebral venous system thrombosis commonly involves the cerebral venous sinuses (CVS), deep cerebral veins, and cerebral cortical veins (CCV)
With regard to cerebral venous sinus thrombosis (CVST) treatment, we previously found that batroxobin, combined with anticoagulation, can safely and effectively improve clinical outcomes and reduce restenosis in patients with acute CVST [14, 15]
We used HR-MRBTI to directly detect cortical vein thrombosis (CCVT). This new magnetic resonance imaging (MRI) sequence was found to be highly accurate for identifying thrombus in cortical veins, and was useful for confirming CCVT in patients with false-negative contrast-enhanced magnetic resonance venography (CE-MRV) or digital subtraction angiography (DSA)
Summary
Cerebral venous system thrombosis commonly involves the cerebral venous sinuses (CVS), deep cerebral veins, and cerebral cortical veins (CCV). Cerebral cortical vein thrombosis (CCVT) shares similar predisposing conditions with cerebral venous sinus thrombosis (CVST), and they are frequently comorbid. CCVT is misdiagnosed due to its non-specific clinical presentation and confounding radiological findings. These factors can lead to delays in treatment. Seizures are one of the most common symptoms of CCVT [1, 4,5,6] Complications such as hemorrhagic infarctions [4], subarachnoid hemorrhages (SAH) [7, 8], and arteriovenous fistulas (AVF) [9,10,11] may arise because of treatment delays
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