Rare cause of cerebral venous sinus thrombosis: Spontaneous intracranial hypotension syndrome: A case report

Abstract

BACKGROUND Spontaneous intracranial hypotension syndrome is a relatively uncommon neurological disorder of unknown etiology with a good prognosis. Cerebral venous sinus thrombosis is a specific type of cerebrovascular disease caused by multiple etiologies of cerebral venous sinus or vein thrombosis that obstructs cerebral venous return and is associated with impaired cerebrospinal fluid absorption; this entity is rarely seen clinically. Spontaneous intracranial hypotension syndrome is one of the causes of cerebral venous sinus thrombosis, and the probability of their combined occurrence is only 1%-2%. As such, it is easily overlooked clinically, thus increasing the difficulty of diagnosis and treatment. CASE SUMMARY A 29-year-old young woman presented with postural headache. Lumbar puncture suggested a pressure of 50 mmH 2 O (normal 80 mmH 2 O-180 mmH 2 O), and magnetic resonance imaging cerebral venography suggested thrombosis of the supratentorial sinus. These findings were considered indicative of cerebral venous sinus thrombosis due to spontaneous intracranial hypotension syndrome after ruling out immunological causes, tumor, infection, abnormal coagulation mechanism, and hypercoagulable state, etc. She was treated with rehydration and low-molecular heparin anticoagulation for 15 d, and follow-up magnetic resonance imaging cerebral venography suggested resolution of the thrombus. The patient had complete improvement of her headache symptoms. CONCLUSION Spontaneous intracranial hypotension syndrome is one of the rare causes of cerebral venous sinus thrombosis, which is frequently misdiagnosed or missed and deserves consideration by clinicians during differential diagnosis. Dehydration should be avoided in such patients, and early rehydration and anticoagulation therapy are effective treatment options.

Spontaneous Intracranial Hypotension Discovered Following Cerebral Venous Thrombosis: A Case Report and Review of the Literature

“…Isolated cortical vein thrombosis is an even rarer complication at 0.4% [5]. We identified 53 previously reported cases, including the present case [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Among these 53 cases, thrombosis involving the cerebral venous sinuses was observed in 38 (71.7%) and isolated cortical vein thrombosis was observed in 15 (28.3%).…”

Cerebral vein thrombosis: from risk factors to recanalization and clinical outcomes. A review

“…По данным литературы, выделяют следующие факторы риска: генетические (тромбофилия, гипергомоцистеинемия, дефицит антитромбина 3, дефицит протеина S и С, мутация MTHRF и протромбина, активатор плазминогена, истинная полицитемия, эссенциальная тромбоцитемия, фактор Лейдена, миелопролиферативное заболевание), гендерные (беременность, послеродовой период, использование оральных контрацептивов), системные ревматологические заболевания (болезнь Бехчета, системная красная волчанка, антифосфолипидный синдром -АФС, наличие антинуклеарных антител), системные заболевания кишечника, заболевание щитовидной железы, нефротический синдром, саркоидоз, пароксизмальная ночная гемоглобинурия, ожирение и инфекционные заболевания (в том числе COVID-19), механические факторы (хирургические вмешательства, в том числе люмбальная пункция и травма головы), прием лекарственных препаратов (витамин А, литиум, внутривенный иммуноглобулин, цитостатики), сосудистые аномалии (артериовенозные фистула и мальформация), злокачественные новообразования, спонтанная внутричерепная гипотензия [1,7,10,17,19,20]. Артериальная гипертония -ведущая сопутствующая патология ЦВТ, за ней следуют курение, сахарный диабет [21].…”