Cerebral venous thrombosis in spontaneous intracranial hypotension: A diagnostic and therapeutic challenge for the neurologist

Abstract

Cerebral venous thrombosis represents 2% of complications due to idiopathic intracranial hypotension and its clinical manifestations and findings in cerebrospinal fluid resembles that of an aseptic meningitis. The difficulty does not end there. One question remain regarding the treatment: Do we start anticoagulation therapy knowing that the risk of intracranial hemorrhage increases due to the intracranial hypotension? Or should we avoid anticoagulation therapy increasing the risk of venous thrombosis complications? We present a 66-year-old man with a 3 year history of orthostatic occipital headache, which is accompanied by a decrease in visual acuity, cognitive deterioration and postural instability. A cranial MRI showed pachymeningeal enhancement, tonsillar herniation and thrombosis of the cerebral venous system. Lumbar puncture showed low opening pressure, hyperproteinorrachia and low glucose index, along with CT myelography and panangiography, the final diagnosis was cerebral venous thrombosis due to idiopathic intracranial hypotension. A decompressive craniotomy was performed and anticoagulation therapy was started. With only 32 cases to date reported around the world, and this being the first in Colombia, there is still much to be defined regarding diagnosis and treatment