Dural puncture: an overlooked cause of cerebral venous thrombosis

Abstract

Cerebral venous thrombosis (CVT) accounts for 0.5-1 % of all strokes. Although dural puncture is proposed as one of the rare risk factors, this association has only been mentioned in anecdotal reports. Headache, i.e., usually the first and the most frequent clinical symptom on admission, is often attributed to the dural puncture itself. We investigated the frequency of CVT following a recent dural puncture in our stroke database, together with the other risk factors. The computerized medical records of patients (n = 10,740) registered in our tertiary-care neurology clinic stroke database were reviewed retrospectively. Patients diagnosed with CVT were reanalyzed. Patients who had a dural puncture in the preceding 7 days were included in the study. A total of 46 patients were diagnosed with CVT. Nine patients (19.6 %) had a recent dural puncture before the onset of the symptoms. Patients were younger than 45 years and had at least one more predisposing condition for thromboembolism other than the dural puncture. All patients have received either spinal anesthesia or intrathecal chemotherapy. Dural puncture seems to trigger CVT particularly in patients with predisposing disorders. Although reported as an extremely rare complication, our data indicate a much higher association. This case series emphasize the importance of reevaluation of patients with persistent/progressive headache following dural puncture. The effect of change in the biochemical composition of CSF due to intrathecal drug administration in pathogenesis is not known. Larger controlled trials are warranted to clarify the causal relationship between lumbar puncture and/or intrathecal drug administration and CVT.

Cerebral Venous Thrombosis After a Possible Inadvertent Dural Puncture for Labor Epidural Analgesia

“…In our case, the development of CVT a week after dural puncture and symptoms, i.e. headache and seizures, are consistent with the published literature [8-9]. The exact mechanism is not known.…”

“…Although the causal relationship could not be established, Guner at al. studied the frequency of cerebral venous thrombosis and dural puncture and found that 19.6% of patients who had a dural puncture in the previous seven days developed CVT [8]. In our case, the development of CVT a week after dural puncture and symptoms, i.e.…”

Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review

“…After lumbar puncture, if the headache is sustained or progressively aggravated or new symptoms appear, especially in patients with CVT susceptibility factors, the possibility of CVT should be considered. Guner et al ( 2015 ) conducted a retrospective study of 46 patients diagnosed with CVT. Of these, 19.6% (9 cases) had a lumbar history before onset.…”

Cerebral venous thrombosis as a complication of intracranial hypotension after lumbar puncture

“…9 10 Importantly, all patients in the study by Guner et al had an additional predisposing risk factor for CVT including inherited thrombophilia or malignancy. 9 The pathogenesis of CVT after a dural puncture is poorly understood. Several mechanisms have been proposed including damage to venous endothelium due to stretch from negative spinal-cranial pressure, decreased venous velocity and reduced absorption of CSF in the sinuses.…”