Clinical and neuroimaging features in patients with spontaneous intracranial hypotension and subsequent cerebral venous thrombosis

Abstract

Objective To investigate the clinical and neuroimaging features in spontaneous intracranial hypotension (SIH) and subsequent cerebral venous thrombosis (CVT). Methods To summary 4 cases of SIH who subsequently developed CVT，focusing on the clinical features，radiological appearances and treatment strategies. Results All patients had postural headaches，stiff neck and epilepsy.Among 4 patients，2 had hemiplegia.Neuroimaging features of SIH and CVT coexisted in all patients.All patients had neuroimaging features of SIH and CVT，freguent features included downward displacement of the brain，subdural effusions and diffuse pachymeningeal gadolinium enhancement.Two patients had cerebral cortical venous thrombosis，and the other 2 patients had superior sagittal sinus thrombosis.All patients had recovered with redressed intracranial hypotension and anticoagulation therapy. Conclusions SIH may be associated with an increased risk of CVT.Clinicians treating patients with SIH must regard the developing CVT.We should consider appropriate imaging if the character of the headache changes，or if the patient develops new signs.Redressed intracranial hypotension and anticoagulation may be an effective method of treatment. Key words: Intracranial hypotension; Intracranial thrombosis; Venous thrombosis; Tomography，X-ray computed; Magnetic resonance imaging