Intracranial hypotension as a contributor to isolated cortical vein thrombosis

Zhang, Dan; Chen, Yin; Wang, Jin; Hu, Xingyue

doi:10.1111/head.14254

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…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%).…”

Section: Discussionmentioning

confidence: 91%

“…CVT as a complication of SIH is rare, with an incidence of only 2.1% [2]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…However, our patient had a favorable outcome. According to previous reports of patients with SIH, 81% of those with CVT involving the cerebral venous sinuses and 83.3% of those with CVT involving the cortical veins achieved full recovery; only one death was reported, indicating a relatively good prognosis [ 5 , 9 ]. This may be attributed to the resolution of intracranial hypotension through conservative treatments or an epidural blood patch, which alleviates venous dilation and traction, making thrombosis less likely to progress.…”

Section: Discussionmentioning

confidence: 99%

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

Hiratsuka,

Ohtake,

Fukuda

et al. 2024

Cureus

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Cerebral venous thrombosis (CVT) is a rare complication of spontaneous intracranial hypotension (SIH). We encountered a case where SIH was discovered after the diagnosis of CVT, suggesting the occurrence of CVT during the acute phase of SIH. We report this rare case of isolated cortical vein thrombosis in the acute phase of SIH. A 48-year-old woman taking low-dose oral contraceptives presented with neck pain, headache, and right-sided weakness. Magnetic resonance imaging and digital subtraction angiography confirmed isolated cortical vein thrombosis. No other specific imaging abnormalities were noted. The patient was initially treated with anticoagulation. Subsequent worsening of her orthostatic headache led to the diagnosis of SIH, with diffuse dural enhancement on gadolinium-enhanced T1-weighted imaging. An epidural blood patch was performed, resulting in a favorable outcome with no neurological deficits. Although CVT can occur in the acute phase of SIH, particularly in patients with thrombophilia, the lack of characteristic imaging findings associated with SIH often complicates the diagnosis.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Hiratsuka,

Ohtake,

Fukuda

et al. 2024

Cureus

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Advanced clinical reasoning in the diagnosis of spinal cerebrospinal fluid leaks

Robbins,

Salama,

Chazen

2024

Headache

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Spinal cerebrospinal fluid (CSF) leaks, including spontaneous intracranial hypotension (SIH) and post-dural puncture headache (PDPH), are important neurological disorders featuring rapidly evolving diagnostic and therapeutic tools. 1 Headache has recently advanced a strong focus on this area. 2,3 The diagnosis can be straightforward based on the clinical picture (spontaneous or post-procedure onset orthostatic headache) with radiological confirmation. However, challenging diagnostic conundrums manifest in clinical practice, particularly for CSF leak centers and other clinicians encountering complex presentations. Here, we frame three important scenarios requiring advanced clinical reasoning.

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Prevalence, clinical presentation, and treatment-management of cerebral venous thrombosis associated with spontaneous intracranial hypotension: A combined case-series and systematic literature review approach

Risi,

Ducros,

van Dokkum

et al. 2024

Interv Neuroradiol

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Background Cerebral venous thrombosis (CVT) is a rare complication of spontaneous intracranial hypotension (SIH). Therefore, its correct diagnosis and the corresponding optimal treatment-management identification remains challenging. Methods Over the last 10 years, 300 patients received a definite SIH diagnosis at our stroke center. Through thorough review of the database, we identified all patients with SIH-related CVT. In addition, we performed a systematic literature review including all publications on SIH-related CVT. Results Five out of our 300 SIH patients showed CVT (F/M:2/3, mean age: 51.8 ± 15.7). Through the literature search, 72 additional cases were identified. Overall, the prevalence was 1.3% and main clinical presentations were orthostatic headache, nausea, and vomiting. The CVT was predominantly located at the superior sagittal sinus. Treatment strategies included anticoagulants (ACs) (43%), epidural blood patch (EBP) (19.4%), and combined AC + EBP (33.3%). In our cohort, all but one patient received combined EBP and AC. The mean clinical and radiological follow-up were 2 years and 1.5 years, respectively. Complete clinical recovery was reported in 96% of the cases, whereas 56% showed complete radiological CVT resolution. Among patients without radiological resolution (26.4%), 57% received AC-only, while 43% received combined AC + EBP. Of our five cases, all but one patient received combined AC + EBP. Conclusion The overall prevalence of SIH-related CVT was 1.3%. AC and combined AC + EBP were the most used treatment-management strategies. CVT resolution was more commonly achieved after the combined strategy. Overall, the rate of complete clinical recovery was 96%.

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Intracranial hypotension as a contributor to isolated cortical vein thrombosis

Cited by 3 publications

References 31 publications

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

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

Advanced clinical reasoning in the diagnosis of spinal cerebrospinal fluid leaks

Prevalence, clinical presentation, and treatment-management of cerebral venous thrombosis associated with spontaneous intracranial hypotension: A combined case-series and systematic literature review approach

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