Ruth Eliahou MD, Presenter: Nothing to Disclose

Asaf Honig MD, Abstract Co-Author: Nothing to Disclose

Ronen Leker MD, Abstract Co-Author: Consultant, MedyMatch Technology Ltd

John Moshe Gomori MD, Abstract Co-Author: Consultant, Medymatch Technology Ltd

Intracranial hypotension (IH) is an increasingly recognized clinical entity with distinct clinical and imaging features. The associated venous distention and sluggish venous flow in IH has been linked to sinus vein thrombosis (SVT). Iatrogenic direct lumbar punctures (LP), spinal anesthesia (SA) or indirect punctures due to epidural anesthesia (EA) are common causes of IH. We studied the occurrence of SVT in patients post LP.

We retrospectively reviewed the imaging and clinical findings of post LP patients with SVT in our institution between 2003 and 2013. 

Eighty patients who presented to our institution in the past 10 years with acute sinus vein thrombosis were identified. Ten of them, all females (ages 22 -52) were found to have an LP 3-7 days before developing SVT. 8 women were post-partum with EA, and two had SA for meniscal surgery and hysterectomy. All patients had postural headaches. CT and MR scans of all ten patients were positive for SVT. In addition, five patients (50%) also showed one or more IH related MR findings: low cerebellar tonsils, decreased mamillo-pontine distance, diffuse pachymeningeal enhancement, thin bilateral subdural fluid collections. Post- partum and postoperative states are known to be hypercoagulable conditions. Subsequent coagulograms revealed underlying hypercoagulable tendencies in all ten patients.  

Clinical and imaging data point to a direct association between IH and SVT. In post-partum women who underwent recent spinal or epidural anesthesia, with diagnosis of SVT one should look for IH. Coexistence of underlying IH may have therapeutic implications.  

There is a strong association between postpartum SVT and IH, caused by recent spinal anethesia  Postpartum SVT should initiate imaging and clinical search for underlying IH.  

Eliahou, R, Honig, A, Leker, R, Gomori, J, Intracranial Hypotension and Sinus Vein Thrombosis - Causal or Casual Association?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014793.html