Humbertjean Lisa, Ducrocq Xavier, Lacour Jean-Christophe, Mione Gioia, Richard Sébastien
Department of Neurology, University Hospital of Nancy, Nancy, France.
J Neuroimaging. 2015 Jul-Aug;25(4):665-7. doi: 10.1111/jon.12203. Epub 2014 Dec 16.
Diagnosis of cerebral cortical venous thrombosis in patients with postdural puncture headache (PDPH) is usually secondary to changes in headache pattern or cerebral infarctions. Nevertheless, incidental discovery of asymptomatic forms on brain imaging has never been reported before and its management thus remains ill-defined. We describe 2 cases of patients with asymptomatic cortical vein thrombosis in the context of PDPH. In both cases, brain computed tomography (CT) scans showed an isolated cortical vein thrombosis without cerebral damage. Neurological examination revealed the typical orthostatic feature of PDPH, independently of cortical vein thrombosis which was considered as a radiological incidental finding. Clinical and radiological signs resolved after bed rest, oral caffeine, and anticoagulation therapy. Asymptomatic cortical vein thrombosis may be found on radiological exploration, even basic like brain CT scan without contrast, of PDPH. Utility of anticoagulation therapy, which could increase the risk of cerebral hemorrhagic complications in this specific context, has to be assessed.
硬膜穿刺后头痛（PDPH）患者的大脑皮质静脉血栓形成诊断通常继发于头痛模式改变或脑梗死。然而，此前从未有过在脑成像中偶然发现无症状形式的报道，因此其治疗方法仍不明确。我们描述了2例PDPH患者出现无症状皮质静脉血栓形成的病例。在这两个病例中，脑部计算机断层扫描（CT）显示孤立的皮质静脉血栓形成，无脑损伤。神经学检查显示出PDPH典型的直立性特征，与被视为放射学偶然发现的皮质静脉血栓形成无关。卧床休息、口服咖啡因和抗凝治疗后，临床和放射学体征消失。在对PDPH进行放射学检查时，即使是像无造影剂的脑部CT扫描这样基本的检查，也可能发现无症状皮质静脉血栓形成。在这种特定情况下可能增加脑出血并发症风险的抗凝治疗的效用，必须进行评估。
