Highlights
- •In patients with spontaneous intracranial hypotension (SIH), cerebral venous thrombosis (CVT) has rarely been observed with an incidence of 1–2%.
- •The first-line therapy for CVT is anticoagulation. Epidural blood patch (EBP) is the main treatment option for SIH.
- •Anticoagulation potential benefit in CVT associated to SIH must be carefully evaluated taking account of the intracranial haemorrhage risk.
- •There is currently insufficient evidence to support definitive treatment guidelines of CVT in SIH.
- •Effective and prompt EBP, even without anticoagulation therapy, might lead to a good prognosis in selected SIH/CVT cases.
Abstract
Background
The occurrence of cerebral venous thrombosis (CVT) in patients with spontaneous intracranial
hypotension (SIH) raises difficult practical questions regarding the management of
the two conditions. The first-line therapy for CVT is anticoagulation (AC); however,
its potential benefit in SIH/CVT patients, especially if complicated by subdural haematoma,
must be carefully evaluated taking account of the intracranial haemorrhage risk. Venous
system recanalization and good prognosis in SIH/CVT patients treated with epidural
blood patch (EBP), the main treatment option for SIH, have been already described.
Methods
We reviewed our cases of SIH complicated by CVT among a cohort of 445 SIH patients
observed and treated during the last years. All published case reports and case series
reporting patients with SIH and CVT were also ascertained and reviewed.
Results
Eight (2%) out of 445 patients suffering with SIH, were also diagnosed with CVT. All
patients observed had orthostatic headache, three of them experienced a change in
their headache pattern over the SIH course. Six out of eight patients received both
AC and EBP treatments. Two patients were treated using only AC or EBP. A bilateral
subdural haematoma enlargement after 1 month of AC was observed in one case. Complete
CVT recanalization after treatment was obtained in three patients, including two with
multiple CVT at baseline; partial CVT recanalization was achieved in two patients.
Three patients experienced no CVT recanalization. After 6–48 months' follow-up all
patients were still asymptomatic.
Conclusions
The use of AC therapy should be weighed against the intracranial haemorrage risk and
should be monitored carefully if initiated. Effective and prompt EBP, even without
AC therapy, might lead to a good prognosis in selected cases.
Keywords
Abbreviations:
cerebral venous thrombosis ((CVT)), spontaneous intracranial hypotension ((SIH)), anticoagulation ((AC)), epidural blood patch ((EBP)), low cerebrospinal fluid ((CSF)), International Classification of Headache Disorders 3rd edition ((ICHD-3)), numeric rating scale ((NRS)), computed tomography ((CT)), intravenous ((iv)), magnetic resonance imaging ((MRI)), magnetic resonance venography ((MRV)), dural artero-venous fistula ((DAVF)), Digital Subtraction Angiography ((DSA)), subdural hematomas ((SDH))To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 18, 2021
Accepted:
April 16,
2021
Received in revised form:
March 30,
2021
Received:
January 14,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
