Isolated Cortical Venous Thrombosis Associated With Intracranial Hypotension Syndrome

Abstract

The association of intracranial hypotension syndrome with cerebral venous thrombosis is rare. We report our experience with isolated cortical venous thrombosis, which developed after unsuccessful epidural anesthesia. Magnetic resonance imaging showed characteristic imaging findings of intracranial hypotension syndrome, such as dural thickening and brain sagging. We also detected right parietal venous hemorrhagic infarction secondary to right-sided cortical venous thrombosis. After the treatment of intracranial hypotension via epidural blood patch, heparin was used to treat cortical venous thrombosis.

Cerebral Venous and Dural Sinus Thrombosis*

“…Thus, isolated CVTs have mostly been described in case reports or in small series [10,[16][17][18][19][20][21]. Yet, more recently, with the advent of modern magnetic resonance (MR) techniques (see below), more and more cases are being reported, raising the suspicion that isolated CVTs indeed are more common than previously thought [11,12,[22][23][24].…”

Cough headache secondary to spontaneous intracranial hypotension complicated by cerebral venous thrombosis

“…Thrombosis may involve both venous sinuses and cortical veins. Sometimes the involvement of cortical veins can be isolated [34] and focal neurological symptoms can be the only clinical manifestation [38]. In the case reported here, cortical vein involvement could be the cause of the right-side parietal syndrome; additionally, the presence of CVT could explain why CSF pressure was normal, as the increase in intracranial pressure usually caused by CVT would actually exert a sort of compensatory effect [38].…”

“…One of the forms with known causative factors is post-lumbar puncture intracranial hypotension [24]. When a low CSF pressure is present, the diagnostic tests and examinations may reveal the following: (1) low CSF opening pressure at lumbar puncture; (2) abnormal MRI findings, such as linear meningeal enhancement, sagging or sinking of the brain [25] and often of the cerebellar tonsils [26], subdural fluid collections, ventricular collapse [27], pituitary enlargement [28], and engorgement and enlargement of venous sinuses [34]; and (3) evidence of the leakage site on CT myelography, NMR myelography [21] and radionuclide cisternography [30]. Variants of the ''typical'' headache from low CSF pressure have also been identified, such as the acephalic form (without headache), the normal meninges form (without dural enhancement), and the normal pressure form (with normal CSF pressure) [31].…”

“…Although SIH is considered a self-limited process, it could also be associated with disabling complications such as cerebral venous thrombosis [33,34], subdural hematoma [35], nerve palsies such as bilateral abducens palsy [36], or hydrocephalus [37].…”

“…Cerebral venous thrombosis (CVT) as a complication of low CSF pressure is rare, but has nonetheless been reported in the medical literature [33,34]. Schievink and Maya [33] in 2008 reported the occurrence of cerebral venous thrombosis in 2.1% of the 141 patients with spontaneous intracranial hypotension evaluated at a tertiary care centre.…”