Cerebral venous thrombosis as a complication of intracranial hypotension after lumbar puncture

Leon Stephen Edwards; Ramesh Cuganesan; Cecilia Cappelen-Smith

doi:10.1136/bmjno-2020-000046

Cerebral venous thrombosis as a complication of intracranial hypotension after lumbar puncture

BMJ Neurol Open. 2020 Sep 30;2(2):e000046. doi: 10.1136/bmjno-2020-000046. eCollection 2020.

Authors

Leon Stephen Edwards^{1

2

3}, Ramesh Cuganesan⁴, Cecilia Cappelen-Smith^{1

2

3}

Affiliations

¹ Department of Neurology, Liverpool Hospital, Liverpool, New South Wales, Australia.
² Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia.
³ South West Sydney Clinical School, University of New South Wales, Liverpool, Sydney, Australia.
⁴ Department of Radiology, Liverpool Hospital, Liverpool, New South Wales, Australia.

Abstract

Background: Optic neuritis is recognised by the international classification of headache disorders as a painful cranial nerve lesion. A lumbar puncture may be performed in the investigation of optic neuritis. Postdural puncture headache (PDPH) due to intracranial hypotension is a frequent complication of this procedure. In contrast, cerebral venous thrombosis (CVT) is a rare but potentially fatal complication of dural puncture. A few studies have identified an association between iron deficiency anaemia and venous thrombosis. There are no reports linking CVT with lumbar puncture and iron deficiency anaemia.

Methods and results: We present a 32-year-old woman with optic neuritis and iron deficiency anaemia complicated by a PDPH and CVT.

Conclusion: CVT should be considered in a patient with persistent headache, recent lumbar puncture and iron deficiency anaemia. Early recognition and treatment of this condition are vital to avoiding mortality and morbidity.

Keywords: headache; sinus thrombosis; stroke.