Cortical Vein Thrombosis, Tortuous Venous Vasculature, and Microhemorrhages in Neurosarcoidosis

Abstract

A previously healthy 13-year-old boy presented with an episode of left-sided facial droop and dysarthria lasting 90 minutes. His initial brain magnetic resonance imaging (MRI) demonstrated a nonenhancing fluid-attenuated inversion recovery hyperintensity in the corpus callosum and right cerebellar peduncle. Small tortuous veins were noted near the peduncular lesion, and punctate foci of susceptibility were noted in the area of the caudate, thalamus, and cerebellum. These were interpreted as a developmental venous anomaly and nonspecific prior injury, respectively. Serum anti–myelin oligodendrocyte glycoprotein and anti–aquaporin-4 antibodies tests were negative, and analysis of cerebrospinal fluid was normal except for a mild lymphocytic pleocytosis (7 leukocytes/mm³ with 1 red blood cell count/mm³) with a negative infectious evaluation. He was monitored closely every 3 months for clinical or radiographic progression. His MRI 8 months after presentation was notable for new and evolving T2 hyperintensities, with linear enhancement along the prior cerebellar lesion, and unchanged focal venous tortuosity and microhemorrhages. Despite several atypical features, this was interpreted as radiographic progression of presumed multiple sclerosis (MS), and he started rituximab infusions. Identify all potential conflicts of interest that might be relevant to your comment. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Err on the side of full disclosure. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response. Not all submitted comments are published. Please see our commenting policy for details.