A Case of Spontaneous Intracranial Hypotension Complicated by Isolated Cortical Vein Thrombosis and Cerebral Venous Infarction

Lai, Ping-Hong; Li, J. Y.; Lo, Yuk-Keung; Wu, Meng-Ni; Liang, Huei‐Lung; Chen, C. K.

doi:10.1111/j.1468-2982.2007.01235.x

Cited by 22 publications

(21 citation statements)

References 9 publications

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“…In addition to headache, neck stiffness, dizziness, nausea, vomiting, blurred vision, change in hearing, and facial numbness and weakness are occasionally experienced. Severe complications such as subdural hemorrhage, cerebral vasoconstriction, intracranial venous thrombosis, seizure, stupor, and even death have been reported [2,3,4,5,6,7]. The syndrome became well recognized after the report of pachymeningeal gadolinium enhancement in the 1990s.…”

Section: Introductionmentioning

confidence: 94%

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Lan²,

Chang³

et al. 2009

Eur Neurol

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Background and Purpose: Spontaneous intracranial hypotension (SIH) is an uncommon, but not rare, cause of headache. We analyzed a series of patients with SIH and attempted to establish a clinical procedure. Methods: We retrospectively reviewed 11 patients with SIH who were admitted between January 2004 and May 2007. Data recorded from patients included basic data, clinical symptoms, neurological imaging studies and treatment. Results: Orthostatic headache was the most common symptom, but there were still 2 patients without orthostatic headache. Diffuse pachymeningeal enhancement was the most common finding in brain MRI study and engorgement of the spinal epidural venous plexus was the most common finding in spinal MRI study. Eight of our patients received epidural blood patches in the lumbar area and 6 of these were symptom-free within 2 weeks. Two patients received spinal MRI immediately after administering the epidural blood patch, and this revealed that most of the blood had spread to the upper cervical area from the lumbar injection. Conclusion: A blind epidural blood patch from the lumbar area is an acceptable procedure even if the area of leakage is unknown. A reasonable clinical procedure for the patients of SIH may minimize the rate of repeat puncture.

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Section: Introductionmentioning

confidence: 94%

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Lan²,

Chang³

et al. 2009

Eur Neurol

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“…Although the majority of patients finally achieved good prognosis, patients still need to go through the potential risks of intracranial hemorrhage, seizure, venous infarct, brain herniation, or even death . For SIH patients with CVT, more aggressive therapies than conservative treatment are needed.…”

Section: Discussionmentioning

confidence: 99%

“…13,21 Although the majority of patients finally achieved good prognosis, patients still need to go through the potential risks of intracranial hemorrhage, seizure, venous infarct, brain herniation, or even death. 5,13,19 For SIH patients with CVT, more aggressive therapies than conservative treatment are needed. Since the development of CVT is closely related to the pathophysiological changes after CSF leak, the primary focus of treatment should be the treatment of spinal CSF leak.…”

Section: Discussionmentioning

confidence: 99%

“…Engorgement of venous structures results in the slowing of venous blood flow . Sagging of the brain may cause traction on cerebral veins and sinuses, resulting in mechanical distortion and deformation of the vessel walls . The loss of CSF reduces CSF absorption into the cerebral venous sinuses, leading to an increase in blood viscosity in the venous system .…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Sagging of the brain may cause traction on cerebral veins and sinuses, resulting in mechanical distortion and deformation of the vessel walls. 5 The loss of CSF reduces CSF absorption into the cerebral venous sinuses, leading to an increase in blood viscosity in the venous system. 3 These 3 mechanisms may predispose an individual to cerebral venous thrombosis (CVT), with a reported incidence of approximately 2%.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Venous Thrombosis in Spontaneous Intracranial Hypotension: A Report on 4 Cases and a Review of the Literature

et al. 2018

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Objective Spontaneous intracranial hypotension is a risk factor for cerebral venous thrombosis. The occurrence of cerebral venous thrombosis in patients with spontaneous intracranial hypotension raises difficult practical questions regarding the management of the 2 conditions. We reviewed our experience and the relevant literature to evaluate these related questions. Methods We retrospectively studied the medical records and imaging studies of patients with spontaneous intracranial hypotension at a tertiary center from January 2007 through January 2017. The main search strategy was a literature review of journal articles in PubMed (1966 to January 2017). Results Among 374 patients with spontaneous intracranial hypotension, 4 were also diagnosed with cerebral venous thrombosis. A literature review yielded an additional 31 cases, including 21 men and 14 women with a mean age of 40.6 years. Of the 35 patients, 8 (22.8%) patients received anticoagulation therapy and epidural blood patch. Nineteen (54.3%) patients were given anticoagulant only. Seven (20%) patients were treated with epidural blood patch only. One (2.9%) patient did not receive epidural blood patch or anticoagulation therapy. There is no difference in terms of age, sex, diagnosis interval, association with other complications, and prognosis between the first 3 groups. Of the 19 patients who received anticoagulation therapy, 4 patients (21.1%) had intracranial hemorrhage or hematoma enlargement after anticoagulation, and one of these 4 patients died following further intracranial hemorrhage. Of the 8 patients who received both anticoagulation and epidural blood patch, 1 patient (12.5%, P = 0.528) developed subdural hematoma after anticoagulation. Of the 5 cases had intracranial hemorrhage aggravation after anticoagulation, 4 were subdural hematoma occurrence or enlargement. Conclusion Cerebral venous thrombosis is a rare but important complication of spontaneous intracranial hypotension. The primary focus of treatment should be the treatment of intracranial hypotension. It could be possible that anticoagulation might increase the risk of intracranial hemorrhage in patients with spontaneous intracranial hypotension, although a firm conclusion could not be drawn based on the limited number of patients currently available. The use of anticoagulation therapy should be prudent and should be monitored carefully if initiated.

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Lumbale Fusion bei Spondylolisthese als ungewöhnliche Ursache symptomatischer Vasospasmen

et al. 2011

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A Case of Spontaneous Intracranial Hypotension Complicated by Isolated Cortical Vein Thrombosis and Cerebral Venous Infarction

Cited by 22 publications

References 9 publications

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Cerebral Venous Thrombosis in Spontaneous Intracranial Hypotension: A Report on 4 Cases and a Review of the Literature

Lumbale Fusion bei Spondylolisthese als ungewöhnliche Ursache symptomatischer Vasospasmen

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