Cerebral Thrombophlebitis in Three Patients with Probable Multiple Sclerosis

Abstract

We report 3 cases of young patients, 2 women and 1 man, who presented a cerebral venous thrombosis following intravenous treatment with high doses of corticosteroids. All of them presented a probable multiple sclerosis according to clinical, biological (CSF) and MRI criteria and were treated for the first time by a bolus of 1,000 mg of methylprednisolone OD during 5 days. All the usual causes of cerebral venous thrombosis were systematically excluded in all of them. The role of corticosteroid treatment in cerebral thrombophlebitis is discussed. All of them underwent a lumbar puncture a few days before corticosteroid treatment and the relationship between lumbar puncture and cerebral thrombophlebitis is also discussed. Cerebral venous thrombosis associated with corticosteroid treatment has rarely been reported. The relationship between corticosteroids and venous thrombosis has already been suggested but has never been clearly understood.

MECHANISMS IN ENDOCRINOLOGY: The spectrum of haemostatic abnormalities in glucocorticoid excess and defect

“…Isolated cases of cerebral VTE after i.v. steroid pulse therapy have been reported in patients with multiple sclerosis (93). A large prospective cohort study in 6550 UK patients with VTE using the General Practice Research Database showed a threefold increased risk of VTE in current users of oral GCs as compared to non-users (94).…”

Lumbar Puncture and Dural Sinus Thrombosis – A Causal or Casual Association?

“…A small number of cases of CVT were described after a dural puncture, either for epidural or spinal anesthesia [1, 2, 3, 4, 5], myelography [4, 6, 7], intrathecal administration of drugs [8, 9]or diagnosis [4, 10, 11, 12, 13, 14, 15, 16]. However, in most of those reports other risk factors for CVT were also present, leading to some doubt about the actual influence of the lumbar puncture (LP) in CVT occurrence.…”

Cerebral venous thrombosis: an unexpected complication from spinal surgery

“…However, to our knowledge, only Miglis and Levine have previously reported a case of CVT following spinal surgery complicated by durotomy, which was treated with the aid of external CSF drainage, presenting a more dramatic outcome and a much shorter follow-up period [4]. Nevertheless, a few reports have associated CVT with other forms of spinal meningeal injury, including spontaneous intracranial hypotension, diagnostic lumbar puncture, myelography, and epidural and spinal anesthesia, as well as intrathecal administration of steroids and cytostatics [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The temporal gap between the iatrogenic injury to the spinal meninges and the diagnosis of CVT has ranged from a few hours to a few days.…”