Cerebral venous thrombosis as a complication of intracranial hypotension after lumbar puncture

Abstract

Background: Optic neuritis is recognised by the international classification of headache disorders as a painful cranial nerve lesion. A lumbar puncture may be performed in the investigation of optic neuritis. Postdural puncture headache (PDPH) due to intracranial hypotension is a frequent complication of this procedure. In contrast, cerebral venous thrombosis (CVT) is a rare but potentially fatal complication of dural puncture. A few studies have identified an association between iron deficiency anaemia and venous thrombosis. There are no reports linking CVT with lumbar puncture and iron deficiency anaemia.

Methods and results: We present a 32-year-old woman with optic neuritis and iron deficiency anaemia complicated by a PDPH and CVT.

Conclusion: CVT should be considered in a patient with persistent headache, recent lumbar puncture and iron deficiency anaemia. Early recognition and treatment of this condition are vital to avoiding mortality and morbidity.

Keywords: headache; sinus thrombosis; stroke.

Figure 1

(A–D) MRI brain (day 5 post-dural puncture) T1-weighted post contrast axial sequences show (A) pachymeningeal enhancement (red arrows), hypointense area (blue arrows) with a focal area of enhancement and prominent surrounding cortical vein enhancement (B) abnormal flow in the right cortical vein (blue arrow) with intraparenchymal haematoma and surrounding oedema (red arrows). (C) Area of prominent signal hypointensity (blue arrow) on susceptibility-weighted imaging sequence with (D) corresponding hyperdensity (blue arrows) on non-contrast CT brain consistent with acute intraparenchymal haematoma.