Spontaneous Intracranial Hypotension with Isolated Cortical Vein Thrombosis and Subarachnoid Haemorrhage

Abstract

Spontaneous intracranial hypotension (SIH) associated with subarachnoid haemorrhage (SAH) has never been reported. Here, we report on a case of a 33-year-old woman with SIH, who developed simple partial sensory seizures 3 weeks later. Neuroimaging studies, including brain computed tomography and angiography, were initially normal, but revealed an isolated cortical venous thrombosis at 3 weeks. One week later, brain magnetic resonance imaging showed SAH around the thrombosed cortical vein. We postulate that the decline in the venous blood flow velocity due to SIH may have resulted in cortical venous thrombosis, which in turn led to rupture of the vessel wall and SAH in this patient.

Subarachnoid hemorrhage in isolated cortical vein thrombosis: are presentation of an unusual condition

“…Once the imaging diagnosis was established and proper therapeutic measures were taken, rapid resolution of the symptoms was achieved. Our case is in accordance with the available reports in the literature regarding the risk factors 13 , symptomatology and outcomes 4,11 , and provides another example of this rare association.…”

“…The concomitance of ICoVT and SAH is even rarer, and to our knowledge there are only 3 reports describing a total of 5 cases of this association 4,10,11 . Another article mentioned a case of ICoVT where the CT revealed "thin hyperdensities between frontal sulci", but this finding was interpreted as "cortical venous stasis and dilatation" 5 .…”

Unrecognised dural puncture resulting in subdural hygroma and cortical vein thrombosis

“…Similar reports of cerebral venous thrombosis complicating either dural puncture or idiopathic intracranial hypotension in nonobstetric patients highlight the rapid progression of postural headache to a severe non-postural headache [15][16][17][18]. It is hypothesised that traumatic damage to the fragile venous endothelial lining due to stretching of the cerebral vessels and relative stasis of blood flow in the vasodilated cerebral vasculature contribute towards thrombosis [15].…”

CT-guided percutaneous translaminar approach for blood patching: case report and technical note

“…Distortions of the nerve trunks may cause dysfunction of the optic and VIth cranial nerves presented clinically by diplopia and visual field abnormalities, respectively, and reported to be improved after appropriate management [16]. Other symptoms, such as, vestibular and auditory symptoms due to variations in intra labyrinthine pressure [4], partial pituitary insufficiency due to traction of the pituitary stalk [12], cortical venous thrombosis due to the decreased venous blood flow velocity [15] and paroxysmal ataxia of gait [4] have been reported. In patients presenting with cranial neurological symptoms (especially orthostatic headache) after spinal surgery, IH syndrome is considered as a differential diagnosis and neuroimaging studies, such as, CT and MRI myelography and RC [1,10,11].…”