Cortical Vein Thrombosis and Cortical Spreading Depolarization

Pathophysiological Plausibility

• Cortical vein thrombosis causes reduced cerebral blood flow and venous infarction, as demonstrated by angiographic studies showing delayed cerebral perfusion and PET imaging revealing reduced cerebral blood flow after venous occlusion, in patients with cerebral venous thrombosis 1, 2

Evidence Gap and Clinical Reality

• The American College of Radiology guidelines and case series do not specifically mention cortical spreading depolarization as a complication of cortical vein thrombosis, despite its pathophysiological plausibility, in patients with cerebral venous thrombosis 1, 2, 3, 4, 5
• Cortical vein thrombosis presents with seizures, focal deficits, and hemorrhagic infarction, in approximately 40% of cases, according to the American Academy of Neurology 6, 7
• Venous congestion with prolonged mean transit time and increased cerebral blood volume creates conditions similar to arterial ischemic stroke, in patients with cortical vein thrombosis 1, 2, 5