Spontaneous Intracranial Hypotension With Cerebral Venous Thrombosis

Objective:The cases of spontaneous intracranial hypotension with cerebral venous thrombosis have been reported,but the relationship of the two entities has not been clear.This study is intended to evaluate the relationship and offer some indications for early diagnosis.Methods:The clinical characters of two diagnosed spontaneous intracranial hypotension with cerebral venous thrombosis cases were analyzed.With reviewing of the literature,the clinical features,assistant examinations and treatment of the cases reported in recent 5 years were also evaluated.Results:Both patients presented with orthostatic headache,with lumber punctures showed the pressures of cerebrospinal fluid below 60mmH₂O and characteristic manifestations of spontaneous intracranial hypotension on cranial magnetic resonance imaging(patient 1 showed subdural fluid collection,patient 2 showed enhancement of meninges).Both patients developed change in the headache pattern,seizure,hemiplegia,neuroimaging indicated cortical venous thrombosis probably caused by isolated cortical vein thrombosis.Both patients did not show other high risk factors of cerebral venous thrombosis.With reviewing of the literature,clinical characters of 22 patients including patients above and patients reported in recent 5 years were generally consistent with literature,but only 10 patients developed change in headache pattern.Conclusions:1.Spontaneous intracranial hypotension is a low volume state of cerebrospinal fluid secondary to the spinal cerebrospinal fluid leak,it is one of the important causes of newly onset daily persistent headaches characterized by orthostatic headache and subdural fluid collection,enhancement of meninges,sagging of brain on cranial magnetic resonance imaging.2.Spontaneous intracranial hypotension could be a rare risk factor of cerebral venous thrombosis,and cerebral venous thrombosis should be doubted when there was a change in head patterns,but headache should not be the only clue.3.The outcome of spontaneous intracranial hypotension with cerebral venous thrombosis is generally well,so early diagnosis and treatment in time is very important.