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Superior sagittal sinus thrombosis in a patient with postdural puncture headache
Honorio T Benzon1, Muhammad Iqbal, Martin S Tallman
1Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. hbenzon@nmff.org
Background And Objectives:
The occurrence of concomitant intracranial pathology in a patient with postdural puncture headache (PDPH) is rare. We present a patient who had a superior sagittal sinus thrombosis in addition to his PDPH. The signs and symptoms of intracranial pathology in patients with dural puncture headache, in addition to their postural headache, are discussed.
Case Report:
A 32-year-old man with lymphoblastic lymphoma received treatment with daunorubicin, vincristine, and prednisone. He developed postural headache and severe nausea and vomiting after a diagnostic lumbar puncture. Magnetic resonance imaging (MRI) showed superior sagittal sinus (SSS) thrombosis and meningeal enhancement. An epidural blood patch was performed and enoxaparin was prescribed for 6 months. He has remained asymptomatic.
Conclusions:
Patients with PDPH have classic postural headache. The occurrence of additional signs and symptoms should alert the clinician to the presence of intracranial pathology. Patients with lymphoblastic lymphoma who had treatment with L-asparaginase and steroid are predisposed to the development of cortical venous thrombosis and may have this syndrome in addition to a dural puncture headache.