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

Abstract

Background: A few cases of cerebral venous thrombosis (CVT) were reported after a lumbar puncture (LP), suggesting a causal association. The purpose of our study was to document that LP might predispose to CVT by decreasing blood flow velocities (BFV) in veins or dural sinus. Methods: We performed a transcranial Doppler ultrasound study to register the mean BFV of the straight sinus (SS) before, during and after LP. Results: Thirteen patients were studied. LP induced a decrease of 47% of mean BFV in the SS. The mean decrease of BFV was significant immediately at the end (p = 0.003), 30 min after (p = 0.015) and more than 6 h after LP (p = 0.008). Conclusions: LP induced a sustained decrease of mean BFV in the SS. The decrease of venous blood flow is a possible mechanism contributing to the occurrence of CVT.

Cerebral venous thrombosis: an unexpected complication from spinal surgery

“…Second, according to the Monro-Kellie hypothesis, a compensatory increase in total blood volume in the intracranial compartment happens to maintain the volume of its content. An important portion of the additional blood volume is accommodated in the capacitance veins and, to a lesser degree, in the venous sinuses, producing an increase in their diameter and a proportional decrease in the blood flow velocity in their interior, as predicted by the hydrodynamic theory and confirmed by MRI and transcranial Doppler ultrasound studies [24][25][26]. During the shift to the erect position, these changes trigger the stimulation of pain receptors located in the meninges, vessels and nerves, which is thought to cause the clinical manifestations of intracranial Eur Spine J CSF hypotension, including the classic post-lumbar puncture headache [27,28].…”

Cerebral Venous Sinus Thrombosis After Cervical Spine Epidural Injection

“…This underlying hypercoagulable state in conjunction with another known risk factor, dural puncture, likely led to the development of CVT in this patient. The postulated mechanism by which dural puncture may contribute to CVT has been theorized by Canhao et al as follows: Dural puncture causes a decrease in CSF volume and pressure which causes a compensatory venodilation which leads to increased blood volume and decreased blood flow which ultimately may lead to venous thrombosis [9].…”

Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion

“…91 Second, there is evidence that after CSF diversion from lumbar puncture, flow in the venous sinuses actually drops and is not increased. 13 Third, in other situations in which there is significant loss of CSF 71 or another component of the cranial cavity, such as brain tissue loss after hemispherectomy, there has been no demonstrated compensatory increase in cerebral venous volume. Fourth and last, as stated earlier, the same pattern of spinal epidural engorgement occurs in cases without CSF loss but in which brain compliance increases and CSF outflow resistance decreases, 14 conditions that would promote cerebral venous overdrainage.…”

“…Should the loss of CSF occur in the supine position, cerebral venous pressures are low and there is slow flow in the outflow veins, which has been demonstrated by Canhão et al, as mentioned previously. 13 On the other hand, if the loss of CSF is accompanied by head elevation without compensatory mechanisms to increase central venous pressure, there will be ensuing cerebral venous overdrainage from the noncollapsible major sinuses into the outflow veins with preferential congestion in the suboccipital cavernous sinus, 29 the "relay station" between the cranial and spinal components of the craniospinal venous system as the venous outflow is redirected from the internal jugular veins to the vertebral venous plexus.…”