Iatrogenic intracranial hypotension and cerebral venous thrombosis.
OBJECTIVE
To assess the manifestations of cerebral venous thrombosis (CVT) associated with intracranial hypotension (IH) following lumbar puncture (LP) or spinal anesthesia (SA).


METHODS
Adult patients with acute CVT unrelated to infection, neurosurgery, or otolaryngological surgery were identified. CVT manifesting within 21days after LP/SA was considered associated with iatrogenic IH. Presentation of patients with and without associate IH was compared.


RESULTS
42 patients were included. 11/42 who had undergone LP/SA presented symptoms and imaging characteristics of IH; 31 had no evidence of IH. Those with IH were more often females (11/11 vs. 21/31, p=0.03), presented sooner after symptom onset (6.0±2.2 vs. 15.6±14days, p=0.002), and rates of venous infarction (45% vs. 23%) and seizures (27% vs. 10%) appeared somewhat elevated (p<0.15). Patients with CVT associated with IH had significantly more cortical vein thrombi (55% vs. 16%, p=0.02). Thrombi were significantly shorter in patients with IH (102±113mm vs. 246±133mm, p=0.002).


CONCLUSIONS
Patients with CVT secondary to IH were typically younger females, and presented with a more acute and severe course with frequent venous infarcts. Although thrombi in the IH group were less extensive, they were more often symptomatic.
Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: Asaf.honig2@gmail.com.
Asaf
A
Honig
Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Ruth
R
Eliahou
Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Y Y
YY
Pikkel
Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Ronen R
RR
Leker
D000328:Adult; D000367:Age Factors; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001921:Brain / Q000000981:diagnostic imaging; D002550:Cerebral Veins / Q000000981:diagnostic imaging; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D019585:Intracranial Hypotension / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D049590:Postpartum Period; D011446:Prospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013129:Spinal Puncture / Q000009:adverse effects*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy
Cerebral venous thrombosis; Dural puncture; Iatrogenic; Intracranial hypotension; Spinal anesthesia; Stroke