Headache and Pain Research

Case Reports

Mechanical Thrombectomy in Cerebral Venous Thrombosis Caused by Spontaneous Intracranial Hypotension: A Case Report with Novel Pathological Findings of Fibrin/Platelet-predominant Thrombus: Min Kyoung Kang, Eun Young Kim, Hye-Rim Shin; Received June 3, 2024 Accepted July 6, 2024 Published online October 2, 2024; DOI: https://doi.org/10.62087/hpr.2024.0016 [Epub ahead of print]

Abstract PDF: This case report presents pathological findings in a rare case of cerebral venous thrombosis (CVT) caused by spontaneous intracranial hypotension (SIH) that was treated successfully with mechanical thrombectomy. The etiologies and prognosis of CVT vary, and CVT resulting from SIH is particularly uncommon and challenging to diagnose and manage. In this case, magnetic resonance imaging revealed signs consistent with both SIH and CVT, which contributed to the patient’s worsening weakness. The patient was treated with a combination of endovascular thrombectomy and epidural blood patch, followed by anticoagulation therapy, and recovered without any complications. A pathological analysis of the retrieved thrombus using hematoxylin and eosin staining showed a high proportion of fibrin and platelets, which could shed light on the mechanism of CVT induced by SIH under conditions of low blood flow due to venous engorgement.

Paradoxical Postural Headache in Spontaneous Intracranial Hypotension with Infratentorial Superficial Siderosis: Dae Woong Bae, Min Seung Kim, Soo-Jin Cho; Korean J Headache. 2023;24(1):20-23. Published online June 30, 2023

Abstract PDF: Spontaneous intracranial hypotension is characterized by orthostatic headache caused by cerebrospinal fluid (CSF) leakage. However, clinical presentation of SIH is variable, and normal or high intracranial pressure in CSF study is not uncommon. Infratentorial superficial siderosis (ISS) shares similar pathomechanism with SIH, as developed after chronic CSF leakage, whilst several years of latency after SIH onset. Here, we report a 47-year-old male patient who had experienced prominent orthostatic headache twenty years before, and presented reverse-orthostatic headache in this time, accompanying with radiological features of SIH and ISS in brain magnetic resonance imaging (MRI). CSF leakage was confirmed by spinal MRI and MR myelography, and his headache was aggravated after epidural blood patch.

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