Isolated cortical venous thrombosis: A systematic review

BackgroundIsolated cortical venous thrombosis (ICVT) is an uncommon subtype of cerebral venous thrombosis that only affects the cortical veins on the cerebral convexities. Its clinical presentation is variable and may mimic other neurological conditions. ObjectiveWe performed a systematic review using PRISMA guidelines of the available literature on ICVT. MethodsWe reviewed articles in PubMed, SCOPUS, and EMBASE databases. We presented the evidence in sections in this manuscript, including epidemiology, clinical presentation, pathophysiology, radiological findings, and proposed treatment. ResultsOf a total of 199 screened studies, we included 39 studies in the final analysis. Of those, 10 were systematic reviews, 11 were case reports, and 18 were case series related to ICVT. Seizures and headaches are the most common symptoms of ICVT. Magnetic resonance venography (MRV) is the diagnostic modality of choice. The standard of care in these cases is therapeutic anticoagulation with heparin and evaluation of an underlying hypercoagulable condition. A half of the patients might require antiepileptic drugs. Osmotherapy and craniectomy are rarely used, and mechanical thrombectomy does not seem to play a role in this patient's treatment. ConclusionIsolated cortical venous thrombosis involves the cortical veins without involvement of the venous sinuses. Patients who usually present with focal seizures and headaches in the absence of a clear cause, the diagnosis of ICVT should be considered. MRV is the diagnostic modality of choice. Therapeutic anticoagulation is the standard of care. More research is required to clarify the role of novel anticoagulants and the duration of the therapy.