Cortical venous thrombosis presenting as MCA infarction mimic

Abstract

A 35-year-old male presented with headache and global aphasia without weakness for 1 day. The clinical diagnosis of left middle cerebral artery (MCA) infarction was confirmed by computed tomography (CT) brain finding of left parieto-temporal infarction. He was first treated with antiplatelet agent. The magnetic resonance imaging (MRI) brain also showed visualization of the hypointense T1/ hyperintense T2 area with restricted diffusion involving the left parietotemporal lobes, compatible with acute infarction. However, there is a tubular lesion and three-jagged edge shape with dark signal intensity in GRE images at the left parietal extra-axial space, as well as dilatation of the left vein of Labbe and prominent left superficial middle cerebral vein, draining to the left transverse sinus. Therefore the diagnosis of left parietal cortical vein thrombosis with collateral drainage was made. The further investigations revealed deficiency of protein S (free protein S= 0 % activity) with compatible with herediatary protein S deficiency. Anticoagulant was considered in this case. Left parietal cortical vein thrombosis can be MCA infarction mimic.