Cortical Brush Sign in Cerebral Venous Thrombosis

A 47-year-old man visited the emergency department reporting a headache.CT and/or CT venography revealed thrombosis in the superior sagittal sinus, right transverse sinus, right internal jugular vein, primarily the right bridging veins, and bilateral cortical veins (Figure 1, A-C).Subcortical hemorrhage was observed in the left parietal lobe (Figure 1D), and venous infarct was observed in the right frontal lobe on MR images (Figure 1, E andF).Susceptibilityweighted imaging (SWI) revealed prominent parenchymal veins perpendicular to the cortical ribbon in the cortex (Figure 1G).This phenomenon, known as the cortical brush sign on SWI, is observed in cerebral venous thrombosis and ischemic infarction. 1 The mechanism of this finding is believed to be due to congestion and blood oxygen level-dependent effects during the acute and subacute phases. 2 Cortical brush sign may be an indicator of the severity of cerebral venous thrombosis.