Neurologic deficits with isolated cortical venous congestion

Isolated cortical vein thrombosis (ICVT) without sinus involvement occurs rarely.1 Clinical diagnosis is often difficult owing to the absence of characteristic clinical features and neuroimaging findings.2 We report a patient with thrombosis of the right cortical vein of Labbe who showed reversible venous congestion with persistent symptoms. A 29-year-old right-handed man was admitted because of an abruptly developed headache and blurred vision, preceded by 4 days of flu-like symptoms. On examination, his blood pressure was 120/80 mm Hg; pulse rate, 89/minute; and body temperature, 37.4 °C. Neurologic examination was normal except for partial impairments in short-term memory and left visual field defect. There was no papilledema. Coagulation tests (including protein C, protein S, antithrombin III, and antiphospholipid antibodies), autoimmune tests (including C reactive protein and antinuclear antibody), and serologic tests for syphilis and herpesviruses were all normal. Perimetry revealed left homonymous hemianopsia involving macular vision. Brain MRI revealed no parenchymal changes in T1- and T2-weighted images (figure, A), but showed abnormally enhanced vessels over right temporo-occipital region …