Cerebral Venous Thrombosis as a Complication of Spontaneous Intracranial Hypotension: A Case Report

Mohammad Ali  Nahayati; Maryam  Payere; Amir  Khanmirzaei; Bahar  Karimikhoshnoudian; Soheil  Shokri-shakib

doi:10.18502/crcp.v10i2.19900

Mohammad Ali Nahayati Neurology Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Maryam Payere Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.
Amir Khanmirzaei School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
Bahar Karimikhoshnoudian School of Medicine, Islamic Azad University of Tehran Medical Sciences, Tehran, Iran
Soheil Shokri-shakib Cardiology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/crcp.v10i2.19900

Keywords: Cerebral venous thrombosis; Spontaneous intracranial hypotension; Anticoagulation therapy; Headache; Neuroimaging

Abstract

Spontaneous intracranial hypotension (SIH) is an uncommon condition caused bycerebrospinal fluid (CSF) leakage, which can lead to complications such as cerebralvenous thrombosis (CVT), occurring in 1–2% of SIH patients. This case report describesthe presentation, diagnosis, and management of SIH complicated by CVT. A 36-year-oldwoman with no comorbidities presented with a three-week history of severe, initiallyorthostatic headaches. Neurological examination revealed mild bilateral disc oedema,and imaging showed generalized brain oedema. MRI with MRV confirmed cerebralvenous sinus thrombosis along with typical SIH features, including pachymeningealenhancement and venous engorgement. She was treated with heparin infusion andisotonic saline, responding well without seizures or hemorrhagic complications.This case highlights the risk of CVT in SIH and underscores the importance of earlydiagnosis through neuroimaging and lumbar puncture. The patient’s favorableresponse to anticoagulation demonstrates effective management, though furtherstudies are needed to establish definitive treatment guidelines for SIH-associated CVT.