Diverse anatomy variation of the cortical veins makes thrombus involving these cortical vessels difficult to diagnose both clinically and radiologically. Due to the rarity of isolated cortical venous thrombus, data on the clinical manifestation and the outcome remained limited, We report the case of a 41year old women, who presented to the Neurology department with ongoing and intractable headaches, and nausea. Brain MR scans showed ill, non-enhancing lesion with low signal intensities(SI) on Gradient echo images, in left anterior temporal pole. Further digital subtraction images showed that the diagnosis of a thrombosed left sphenoidal sinus and venous congestion of left anterior temporal area. The laboratory findings indicated the severe iron-deficiency anemia. After the 2 months of oral anticoagulation, the headache improved and follow-up MR images revealed that lesion with partial resolution of the thrombus. The venous infarction related to thrombosed cortical sphenoidal sinus is a rare clinical finding. If diagnosed early and treated properly, outcomes seem favorable. If the patients with unexplained edema in the anterior temporal area, venous thrombosis of sphenoidal sinus might be ruled out.
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