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Intracranial hypotension as a contributor to isolated cortical vein thrombosis

Dan Zhang1, Yin Chen1, Jin Wang1

  • 1Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.

Headache
|February 9, 2022
PubMed

Insights

Isolated cortical vein thrombosis (ICVT) can be caused by intracranial hypotension (IH). Early diagnosis of ICVT in IH patients, considering clinical and imaging features, is crucial for a favorable prognosis.

Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • Isolated cortical vein thrombosis (ICVT) is a rare and challenging diagnosis within cerebral venous thrombosis (CVT).
  • Intracranial hypotension (IH) is a known potential cause of CVT.
  • Spinal cerebrospinal fluid leakage is a common cause of IH.

Purpose of the Study:

  • To review the clinical and imaging characteristics of ICVT in patients with IH.
  • To investigate the incidence and presentation of ICVT secondary to IH.
  • To identify key features aiding early diagnosis and improving patient outcomes.

Main Methods:

  • Literature review of ICVT associated with IH.
  • Retrospective analysis of ICVT cases in patients with IH from a single hospital (January 2007 - November 2019).
  • Inclusion of 26 patients (3 from the hospital, 23 from literature).

Main Results:

  • Headache (100%), focal neurological deficits (53.8%), and seizures (34.6%) were common symptoms.
  • Orthostatic headache was present in 96.2% of patients.
  • Neuroimaging revealed cord sign (61.5%) and parenchymal brain lesions (46.2%), including hemorrhage (30.8%).
  • Anticoagulation (69.2%) and epidural blood patch (65.4%) were common treatments.
  • Most patients (92.3%) achieved complete recovery.

Conclusions:

  • Intracranial hypotension should be considered in the differential diagnosis of ICVT.
  • Recognizing clinical and neuroimaging features of ICVT in IH patients is vital for timely diagnosis.
  • Early diagnosis facilitates prompt treatment and leads to favorable prognoses.
Abstract

Keywords:
intracranial hypotensionisolated cortical vein thrombosispost-dural puncture headachespontaneous intracranial hypotension

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