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Table 2: All the reported data of patients with cerebral venous thrombosis and spontaneous intracranial hypotension in whom the
site of cerebrospinal fluid leak was demonstrated.
Authors Year Age Gender OP Location of CSF leak AC EBP
Flemming and Link [6] 2005 31 M ? Cervical/Thoracic Yes No
Kataoka et al. [7] 2007 45 M 40 Cervical/Thoracic Yes Yes
Albayram et al. [8] 2007 45 M ? Thoracic Yes Yes
Wang et al. [9] 2007 33 F 80 Cervical No Yes
Tan et al. [10] 2008 26 F 50 Thoracic Yes Yes
Schievink and Maya [11] 2008 32 M 0 Thoracic Yes Yes
Schievink and Maya [11] 2008 43 M 40 Thoracic Yes Yes
Yoon et al. [12] 2011 26 M 50 Cervical No Yes
Dangra et al. [13] 2011 35 M ? Cervical Yes No
M. C. Garcia-Carreira et al. [14] 2014 29 F 30 Thoracic Yes Yes
M. C. Garcia-Carreira et al. [14] 2014 54 M 20 Thoracic Yes Yes
Present Case 2015 48 M 50 Cervical No Yes
CSF: cerebrospinal fluid; OP: opening pressure (mm H 2 O); AC: anticoagulation; EBP: epidural blood patch; age (years); M: male; F: female.
reported in any patient. persist even after bed rest and adequate hydration,
epidural blood patching could be considered.
In 2014, Garcia-Carreira et al. described two cases of Anticoagulation for CVT can be withheld till the
[14]
spontaneous intracranial hypotension associated with symptoms of SIH get controlled. The mortality of CVT
cerebral venous thrombosis. In one case, extensive is 5% but with SIH, it can be increased. Therefore
cerebral venous thrombosis involved the superior firstly SIH should be treated.
sagittal sinus and multiple cortical cerebral veins.
In the other case, only a right frontoparietal cortical In 2013, Güler et al. reported a case of cerebral
[18]
vein was involved. When spontaneous intracranial venous thrombosis accompanying with intracranial
hypotension and cerebral venous thrombosis occur hypotension. They advocated anticoagulation for
together, it raises difficult practical questions about this patient only after SIH symptoms resolved. CVT
the treatment of these two conditions. In most is not reported in any SIH case after the resolution
reported cases, spontaneous intracranial hypotension of symptoms. So, in our patient we tried to treat
was treated conservatively and cerebral venous the primary cause, SIH and hence anticoagulation
thrombosis was treated with anticoagulation. Garcia- was precluded. We advocate primary treatment of
Carreira et al. supported aggressive treatment of the the underlying spinal CSF leak, particularly when
[14]
underlying cerebrospinal fluid leak. symptoms of SIH persist. In our patient, we did an
autologous epidural blood patch at the site of CSF
Again in 2015, Wang E and Wang D reported a case leak under CT guidance and the patient improved.
of successful treatment of a patient with spontaneous In addition, the patient had no residual symptoms or
intracranial hypotension correlated with MRI finding recurrence at six-month follow-up. We think that our
of cerebrospinal fluid (CSF) leak with extradural case can add additional information to the literature
collection at the upper cervical spinal level. This regarding the management of CVT in SIH.
[17]
patient received two lumbar epidural blood patches
without lasting relief. Later on, the radiographic Financial support and sponsorship
evidence of prominent CSF leak with extradural fluid Nil.
collection was noted at C1-2 level. The patient was then
treated with a cervical epidural blood patch, which Conflicts of interest
provided headache pain relief lasting 6 months. A There are no conflicts of interest.
second cervical epidural blood patch was performed,
and the patient was headache free since then. REFERENCES
Table 2 shows all the reported data of patients 1. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks.
with cerebral venous thrombosis and spontaneous 2. Cephalalgia 2008;28:1345-56.
Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and
intracranial hypotension in whom the site of intracranial hypotension. JAMA 2006;295:2286-96.
cerebrospinal fluid leak was demonstrated. All these 3. Mokri B, The Monro-Kellie hypothesis: applications in CSF
patients who received EBP responded very well and 4. volume depletion. Neurology 2001;56:1746-8.
Fabricius J, Klotz JM, Hofmann E, Behr R, Neumann-Haefelin
was symptom free during the follow up. T. Cerebral venous thrombosis and subdural hematoma:
complications of spontaneous intracranial hypotension. Fortschr
There remain some controversies in treatment of Neurol Psychiatr 2012; 80:599-601.
SIH complicated with CVT. Primary conservative 5. Flemming KD, Link MJ. Spontaneous CSF leak complicated by
management of SIH accompanied by anticoagulation venous thrombosis and dural arteriovenous fistula. Cephalalgia
2005; 25:751-3.
for CVT is usually advised. If the symptoms of SIH 6. Kataoka H, Tanizawa E, Ueno S. Spontaneous intracranial

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