Journal of Neurology

, Volume 253, Issue 9, pp 1197–1202

Dural sinus thrombosis in spontaneous intracranial hypotension

Hypotheses on possible mechanisms
  • Mario Savoiardo
  • Silvia Armenise
  • Pantaleo Spagnolo
  • Tiziana De Simone
  • Maria Luisa Mandelli
  • Alessandra Marcone
  • Giancarlo Morciano
  • Cosma Andreula
  • Eliana Mea
  • Massimo Leone
  • Luisa Chiapparini
ORIGINAL COMMUNICATION

Abstract

Dural sinus thrombosis (DST) is rarely associated with spontaneous intracranial hypotension (SIH). Engorgement of the venous system, caused by the CSF loss that occurs in SIH, is considered to favour the thrombosis, although signs of both SIH and DST are usually seen simultaneously at the first diagnostic MRI. We observed two patients with SIH and DST. Changes in pattern of headaches and MRI findings demonstrated that DST followed SIH. In SIH, the velocity of the blood flow in the dural sinuses may be reduced because of dilatation of the venous system which compensates the CSF loss. Other possible mechanisms seem unlikely on the grounds of both clinical presentation and MRI studies.

Keywords

spontaneous intracranial hypotension CSF loss dural sinus thrombosis venous hypervolemia blood flow velocity 

References

  1. 1.
    Aidi S, Chaunu MP, Biousse V, Bousser MG (1999) Changing pattern of headache pointing to cerebral venous thrombosis after lumbar puncture and intravenous high-dose corticosteroids. Headache 39:559–564PubMedCrossRefGoogle Scholar
  2. 2.
    Bakshi R, Mechtler LL, Kamran S, Gosy E, Bates VE, Kinkel PR, Kinkel WR (1999) MRI findings in lumbar puncture headache syndrome: abnormal dural-meningeal and dural venous enhancement. Clin Imaging 23:73–76PubMedCrossRefGoogle Scholar
  3. 3.
    Barrett J, Alves E (2005) Postpartum cerebral venous sinus thrombosis after dural puncture and epidural blood patch. J Emerg Med 28:341–342PubMedCrossRefGoogle Scholar
  4. 4.
    Berroir S, Grabli D, Heran F, Bakouche P, Bousser MG (2004) Cerebral sinus venous thrombosis in two patients with spontaneous intracranial hypotension. Cerebrovasc Dis 17:9–12PubMedCrossRefGoogle Scholar
  5. 5.
    Borum SE, Naul LG, McLeskey CH (1997) Postpartum dural venous sinus thrombosis after postdural puncture headache and epidural blood patch. Anesthesiology 86:487–490PubMedCrossRefGoogle Scholar
  6. 6.
    Brugeilles H, Pénisson-Besnier I., Pasco A, Oillic P, Lejeune P, Mercier P (1996) Cerebral venous thrombosis after myelography with iopamidol. Neuroradiology 38:534–536PubMedGoogle Scholar
  7. 7.
    Canhão P, Batista P., Falcão F (2005) Lumbar puncture and dural sinus thrombosis. A causal or casual association? Cerebrovasc Dis 19:53–56PubMedCrossRefGoogle Scholar
  8. 8.
    Chiapparini L, Farina L, D’Incerti L, Erbetta A, Pareyson D, Carriero MR, Savoiardo M (2002) Spinal radiological findings in nine patients with spontaneous intracranial hypotension. Neuroradiology 44:143–150PubMedCrossRefGoogle Scholar
  9. 9.
    Fishman RA, Dillon WP. Some lessons learned about the diagnosis and treatment of spontaneous intracranial hypotension (1998) AJNR Am J Neurorad 19: 1001–1002Google Scholar
  10. 10.
    Flemming KD, Link MJ (2005) Spontaneous CSF leak complicated by venous thrombosis and dural arteriovenous fistula. Cephalalgia 25:751–753PubMedCrossRefGoogle Scholar
  11. 11.
    Hochman MS, Naidich TP, Kobetz SA, Fernandez-Maitin A (1992) Spontaneous intracranial hypotension with pachymeningeal enhancement on MRI. Neurology 42:1628–1630PubMedGoogle Scholar
  12. 12.
    Li JY, Lai PH, Chao KH, Peng NJ (2005) Spontaneous intracranial hypotension: clinical and neuroimaging spectrum. Neurology 64(Suppl 1):A351Google Scholar
  13. 13.
    Milhaud D, Heroum C, Charif M, Saulnier P, Pages M, Blard JM (2000) Dural puncture and corticotherapy as risk factors for cerebral venous sinus thrombosis. Eur J Neurol 7:123–124PubMedCrossRefGoogle Scholar
  14. 14.
    Miyazawa K, Shiga Y, Hasegawa T, Endoh M, Okita N, Higano S, Takahashi S, Itoyama Y (2003) CSF hypovolemia versus intracranial hypotension in “spontaneous intracranial hypotension syndrome”. Neurology 60:941–947PubMedGoogle Scholar
  15. 15.
    Mokri B (1999) Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia – Evolution of a concept. Mayo Clin Proc 74:1113–1123PubMedCrossRefGoogle Scholar
  16. 16.
    Mokri B (2001) The Monro-Kellie hypothesis. Applications in CSF volume depletion. Neurology 56:1746–1748PubMedGoogle Scholar
  17. 17.
    Mokri B (2003) Headaches caused by decreased intracranial pressure: diagnosis and management. Curr Opin Neurol 16:319–326PubMedCrossRefGoogle Scholar
  18. 18.
    Mokri B, Atkinson JLD, Piepgras DG (2000) Absent headache despite CSF volume depletion (intracranial hypotension). Neurology 55:573–575PubMedGoogle Scholar
  19. 19.
    Mokri B, Hunter SF, Atkinson JLD, Piepgras DG (1998) Orthostatic headaches caused by CSF leak but with normal CSF pressure. Neurology 51:786–790PubMedGoogle Scholar
  20. 20.
    Pannullo SC, Reich JB, Krol G, Deck MDF, Posner JB (1993) MRI changes in intracranial hypotension. Neurology 43:919–926PubMedGoogle Scholar
  21. 21.
    Rando TA, Fishman RA (1992) Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology 42:481–487PubMedGoogle Scholar
  22. 22.
    Roll JD, Larson TC III, Soriano MM (2003) Cerebral angiographic findings of spontaneous intracranial hypotension. AJNR Am J Neuroradiol 24:707–708PubMedGoogle Scholar
  23. 23.
    Settipani N, Piccoli T, La Bella V, Piccoli F (2004) Cerebral venous sinus expansion in post-lumbar punture headache. Funct Neurol 19:51–52PubMedGoogle Scholar
  24. 24.
    Shimazu N, Oba H, Aoki S, Monzawa S, Makita K, Araki T (1998) Pituitary enlargement in spontaneous intracranial hypotension on MRI. Nippon Higaku Hoshasen Gakkai Zasshi 58:349–352Google Scholar
  25. 25.
    Sopelana D, Marcos A, Arroyo R, Gutiérrez E, Cuenca R, Vázquez AV, González JL, Egido JA (2004) May intracranial hypotension be a cause of venous sinus thrombosis? Eur Neurol 51:113–115PubMedCrossRefGoogle Scholar
  26. 26.
    Stocks GM, Wooller DJA, Young JM, Fernando R (2000) Postpartum headache after epidural blood patch: investigation and diagnosis. Br J Anaesth 84:407–410PubMedGoogle Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  • Mario Savoiardo
    • 1
  • Silvia Armenise
    • 2
  • Pantaleo Spagnolo
    • 3
  • Tiziana De Simone
    • 1
  • Maria Luisa Mandelli
    • 1
  • Alessandra Marcone
    • 4
  • Giancarlo Morciano
    • 3
  • Cosma Andreula
    • 5
  • Eliana Mea
    • 6
  • Massimo Leone
    • 6
  • Luisa Chiapparini
    • 1
  1. 1.Department of NeuroradiologyIstituto Nazionale Neurologico “C. Besta”Italy
  2. 2.Department of RadiologyCard. G. Panico HospitalTricaseItaly
  3. 3.Department of RadiologyF. Ferrari HospitalCasaranoItaly
  4. 4.Department of NeurologySan Raffaele HospitalVille TurroItaly
  5. 5.Department of NeuroradiologyCittà di LecceMariaItaly
  6. 6.Department of NeurologyIstituto Nazionale Neurologico “C. Besta”Italy

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