• Spontaneous intracranial hypotension
• anticoagulant therapy
• cerebral venous thrombosis
• epidural blood patch
• isolated cortical vein thrombosis

• CSF
• CSF DYNAMICS
• HEADACHE
• NEURORADIOLOGY

• Humans
• Intracranial Hypotension/diagnosis
• Intracranial Hypotension/diagnostic imaging
• Headache/diagnostic imaging
• Headache/etiology
• Magnetic Resonance Imaging/adverse effects
• Cerebrospinal Fluid Leak/complications

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.

A 29-year-old young woman presented with postural headache. Lumbar puncture suggested a pressure of 50 mmH₂O (normal 80 mmH₂O-180 mmH₂O), 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.

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
• Cerebral venous sinus
• Thrombosis
• Rehydration
• Anticoagulation
• Case report

• Cerebral venous thrombosis
• Clinical characteristics analysis
• Clinical diagnosis
• Headache

• Brain sag
• cerebral vein thrombosis
• intracranial hypotension

• Humans
• Intracranial Hypotension/diagnostic imaging
• Intracranial Hypotension/epidemiology
• Intracranial Hypotension/complications
• Cerebral Veins/diagnostic imaging
• Prevalence
• Cranial Sinuses
• Intracranial Thrombosis/diagnostic imaging
• Intracranial Thrombosis/epidemiology
• Intracranial Thrombosis/etiology
• Thrombosis
• Sinus Thrombosis, Intracranial/diagnostic imaging
• Sinus Thrombosis, Intracranial/epidemiology
• Sinus Thrombosis, Intracranial/complications

• Female
• Humans
• Adult
• Post-Dural Puncture Headache/therapy
• Peripartum Period
• Vasoconstriction
• Headache/therapy
• Cerebrovascular Disorders/complications
• Blood Patch, Epidural/adverse effects
• Venous Thrombosis/etiology
• Venous Thrombosis/complications

• CSF leak
• low CSF pressure headache
• orthostatic headache
• pachymeningeal enhancement
• post-dural puncture headache
• spontaneous intracranial hypotension

• intracranial hypotension
• isolated cortical vein thrombosis
• post-dural puncture headache
• spontaneous intracranial hypotension

Cerebral vein and dural sinus thrombosis (CVT) is a rare but important complication of spontaneous intracranial hypotension (SIH). The diagnosis is difficult in cases lacking typical symptoms and typical imaging findings.

A 29-year-old male patient with a seizure attack was admitted to our hospital. Based on the head imaging findings, we misdiagnosed the patient with primary cerebral parenchymal lesion and performed an open biopsy. However, during the procedure, the patient was diagnosed with low cerebrospinal fluid pressure and cerebral cortical vein thrombosis.

Thus, CVT due to SIH should be considered as a probable cause of secondary parenchymal lesions.

• Cerebral vein and dural sinus thrombosis
• Isolated cortical venous thrombosis
• Parenchymal lesion
• Spontaneous intracranial hypotension

• CSF leak
• Epidural blood patch
• Orthostatic headache

• CSF leak
• Cerebral venous thrombosis
• Deep brain swelling
• Epidural blood patch
• Midbrain swelling
• Orthostatic headache

• cerebral venous thrombosis
• coma
• intracranial hypotension
• subdural hematoma

Spontaneous intracranial hypotension (SIH) is rare but can lead to life-threatening complications including cerebral venous thrombosis (CVT). The concurrence of CVT and SIH raises questions regarding priority.

We present the case of a 52-year-old woman who developed sudden left-sided hemiparesis and generalized tonic-clonic seizures. She experienced progressive orthostatic headaches over the prior 2 weeks. Imaging showed thrombosis in the left transverse and sigmoid sinuses, bilateral subdural hematomas, and a cervicothoracic cerebrospinal fluid leak. Low molecular weight heparin was administered, but it was discontinued 2 days later due to subarachnoid hemorrhage. She was transferred to our hospital where an epidural blood patch was applied immediately, which resulted in complete symptom relief.

CVT is a rare complication of SIH that may result in devastating consequences. Treatment of SIH should be the primary focus. Prompt diagnosis and EBP application can result in a good outcome.

• Cerebral venous thrombosis
• Epidural blood patch
• Spontaneous intracranial hypotension

• cerebral venous thrombosis
• cerebrospinal fluid
• spinal trauma
• spinocerebellar ataxias

• Accidental Falls
• Aged
• Blood Patch, Epidural/methods
• Cerebrospinal Fluid Leak/etiology
• Cerebrospinal Fluid Leak/therapy
• Female
• Humans
• Spinal Injuries/complications
• Spinocerebellar Ataxias/complications
• Treatment Outcome
• Venous Thrombosis/etiology
• Venous Thrombosis/therapy

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Cerebral sinus venous thrombosis is a rare cause for a subdural hematoma and should be considered in the differential diagnosis of such cases.

Diagnosing cerebral sinus venous thrombosis (CSVT) manifested as a spontaneous subdural hematoma (SDH) is challenging due to variability of its clinical features. The neuroradiological investigation is crucial to confirm the diagnosis. The management of SDH secondary to CVST is controversial and not well established.

We present a case of an adult man with Down’s syndrome who underwent a left-sided craniotomy and evacuation of spontaneous subdural hematoma. Post-surgery magnetic resonance venography (MRV) revealed venous sinus thrombosis in the right transverse sinus with loss of flow signal. He was started on Apixaban two weeks post-surgery. Three months later, the patient re-presented with recurrence of the SDH. His anticoagulation was discontinued, and he underwent craniotomy reopening and evacuation of the recurrent hematoma. The patient returned to his baseline following this procedure. The patient was followed up in the out-patient clinic regularly. Interval brain MRI and MRV performed at six months showed further resolution of the thrombosis of the right sigmoid sinus with restoration of the venous flow.

The management of SDH complicating CVST remains controversial due to the rarity of its presentation and the hazards associated with the use of anticoagulation.

• Anticoagulation
• Cerebral venous sinus thrombosis
• Craniotomy
• Subdural hematoma