A case of isolated cortical vein thrombosis with seizures of occipital lobe origin

Background Isolated cortical venous thrombosis (ICVT) is a rare subtype of cerebral venous thrombosis that typically occurs without the involvement of dural sinuses and is often underdiagnosed due to its nonspecific presentation. The incidence of ICVT is low, and it is frequently associated with symptoms such as seizures, headaches, and focal neurological deficits. In addition, ICVT presenting with occipital lobe seizures is extremely rare, and clinicians have limited knowledge about the clinical manifestations of occipital lobe epilepsy (OLE) and its characteristic EEG findings, making it prone to being missed or misdiagnosed. Case presentation: An elderly man presented with blurred vision in both eyes and rapidly progressed to clustered focal seizures (staring to the right gaze deviation with right eye myoclonus) and later evolved into generalized tonic-clonic seizures that refractory to antiepileptic drugs. Imaging showed SWI hypointensity, MRI T1-weighted punctate hyperintensity, and T2 hyperintense signal in the left occipital lobe proximal cortex, with no enhancement observed on enhanced scanning. Electroencephalogram (EEG) confirmed that the seizure originated from the left occipital lobe and spread to the temporo-parietal lobe and both cerebral hemispheres. The diagnosis of ICVT with occipital lobe seizures was confirmed by other examination results. The seizures were effectively controlled following initiation of anticoagulation therapy, and no recurrence was observed after 3 months of follow-up. Conclusion This case of ICVT presenting with occipital lobe seizures can be manifested as clustered focal seizures with rapid generalization. The characteristic manifestations of small occipital hemorrhagic lesions with swelling of local brain tissue on MRI and abnormal discharges originating from the occipital lobe on EEG are important diagnostic indicators. Early recognition of these specific findings and prompt initiation of anticoagulation therapy, can effectively control epilepsy and improve prognosis.