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Introduction Cortical venous thrombosis is a rare and underrepresented etiology for atypical cortical intracerebral hemorrhages (ICH). Cortical venous thrombosis poses a diagnostic challenge compared to dural venous sinus thrombosis. Venogram studies may show a dural sinus filling defect in cases but may not demonstrate thrombosed cortical veins, especially given their variable anatomy. Our aim was to identify cases of atypical cortical ICH in the absence of other secondary ICH risk factors that may have been associated with cortical venous thrombosis. Methods Retrospective chart review of cases of nonaneurysmal ICH over a 3‐year period at our comprehensive stroke center were reviewed. Imaging study and clinical data were reviewed to include only atypical cortical hemorrhages. All subjects were required to have computed tomography (CT) with thin 0.625 mm slices, CT angiogram (CTA) that included venous phases, diagnostic cerebral angiograms without identifiable vascular etiologies, and MR imaging. Atypical ICH was defined as cortical hemorrhage in the absence of vascular malformation, hematological disorders, suspected amyloid angiopathy, hypertension, trauma, dural venous sinus thrombosis, and other secondary etiologies. Social science statistics software was used for data analysis. Results From April 2019 to July 2022, out of 344 total ICH cases, 10 cases were deemed idiopathic despite rigorous investigation, including evaluation for venous sinus thrombosis. Six subjects were male. Mean age was 46.5 (95% CI 35.99, 57.02), and median NIHSS was 7 (95% CI 1.86, 12.54). Two of the ten patients were identified to have ICH‐adjacent hyperdense cortical vein on CT indicating thrombosis. On MRI brain, both patients had susceptibility weighted imaging (SWI) blooming within an adjacent cortical vein as well as hyperintense filling defect of veins on T2 sequence. Conclusions In our study population of atypical intracerebral hemorrhages, cortical venous thrombosis was identified in 20% of subjects. Cortical venous thrombosis may not represent a rare etiology in this unique patient population. Multimodal neuroimaging may be required to identify this underdiagnosed pathology. |
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