title: [Cerebral venous thrombosis after spinal anesthesia: case report].
abstract: BACKGROUND
  Cerebral venous thrombosis (CVT) is a rare, but serious complication after spinal anesthesia. It is often related to the presence of predisposing factors, such as pregnancy, puerperium, oral contraceptive use, and malignancies. Headache is the most common symptom. We describe a case of a patient who underwent spinal anesthesia who had postoperative headache complicated with CVT.
  
  
  METHODS
  Male patient, 30 years old, ASA 1, who underwent uneventful arthroscopic knee surgery under spinal anesthesia. Forty-eight hours after the procedure, the patient showed frontal, orthostatic headache that improved when positioned supine. Diagnosis of sinusitis was made in the general emergency room, and he received symptomatic medication. In subsequent days, the headache worsened with holocranial location and with little improvement in the supine position. The patient presented with left hemiplegia followed by tonic-clonic seizures. He underwent magnetic resonance venography; diagnosed with CVT. Analysis of procoagulant factors identified the presence of lupus anticoagulant antibody. The patient received anticonvulsants and anticoagulants and was discharged eight days without sequelae.
  
  
  CONCLUSIONS
  Any patient presenting with postural headache after spinal anesthesia, which intensifies after a plateau, loses its orthostatic characteristic or become too long, should undergo imaging tests to rule out more serious complications, such as CVT. The loss of cerebrospinal fluid leads to dilation and venous stasis that, coupled with the traction caused by the upright position, can lead to TVC in some patients with prothrombotic conditions.
authors.affiliation: Universidade Federal do Triângulo Mineiro, Disciplina de Anestesiologia, Uberaba, MG, Brasil; Universidade Federal do Triângulo Mineiro, Hospital de Clínicas, Uberaba, MG, Brasil. Electronic address: flora@mednet.com.br.
authors.forename: Flora Margarida Barra
authors.initials: FMB
authors.lastname: Bisinotto
authors.affiliation: Universidade Federal do Triângulo Mineiro, Disciplina de Neurocirurgia, Uberaba, MG, Brasil.
authors.forename: Roberto Alexandre
authors.initials: RA
authors.lastname: Dezena
authors.affiliation: Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil.
authors.forename: Tania Mara Vilela
authors.initials: TMV
authors.lastname: Abud
authors.affiliation: Universidade de Ribeirão Preto, Ribeirão Preto, SP, Brasil.
authors.forename: Laura Bisinotto
authors.initials: LB
authors.lastname: Martins
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D006801:Humans; D020767:Intracranial Thrombosis / Q000150:complications / Q000209:etiology*; D008297:Male; D051299:Post-Dural Puncture Headache / Q000150:complications / Q000209:etiology*; D020246:Venous Thrombosis / Q000150:complications / Q000209:etiology*
keywords: Cerebral venous thrombosis; Complications post‐dural puncture headache; Complicações cefaleia pós‐punção da dura‐máter; Raquianestesia; Spinal anesthesia; Trombose venosa cerebral