title: Incidental Diagnosis of Cerebral Cortical Venous Thrombosis in Postdural Puncture Headache on Brain Computed Tomography.
abstract: Diagnosis of cerebral cortical venous thrombosis in patients with postdural puncture headache (PDPH) is usually secondary to changes in headache pattern or cerebral infarctions. Nevertheless, incidental discovery of asymptomatic forms on brain imaging has never been reported before and its management thus remains ill-defined. We describe 2 cases of patients with asymptomatic cortical vein thrombosis in the context of PDPH. In both cases, brain computed tomography (CT) scans showed an isolated cortical vein thrombosis without cerebral damage. Neurological examination revealed the typical orthostatic feature of PDPH, independently of cortical vein thrombosis which was considered as a radiological incidental finding. Clinical and radiological signs resolved after bed rest, oral caffeine, and anticoagulation therapy. Asymptomatic cortical vein thrombosis may be found on radiological exploration, even basic like brain CT scan without contrast, of PDPH. Utility of anticoagulation therapy, which could increase the risk of cerebral hemorrhagic complications in this specific context, has to be assessed.
authors.affiliation: Department of Neurology, University Hospital of Nancy, Nancy, France.
authors.forename: Lisa
authors.initials: L
authors.lastname: Humbertjean
authors.affiliation: Department of Neurology, University Hospital of Nancy, Nancy, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Ducrocq
authors.affiliation: Department of Neurology, University Hospital of Nancy, Nancy, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lacour
authors.affiliation: Department of Neurology, University Hospital of Nancy, Nancy, France.
authors.forename: Gioia
authors.initials: G
authors.lastname: Mione
authors.affiliation: Department of Neurology, University Hospital of Nancy, Nancy, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Richard
mesh_terms: D000328:Adult; D002533:Cerebral Angiography / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D033162:Incidental Findings; D051299:Post-Dural Puncture Headache / Q000150:complications / Q000175:diagnosis*; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Cerebral venous thrombosis; brain computed tomography; isolated cortical vein thrombosis; postdural puncture headache