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Changing Pattern of Headache Pointing to Cerebral Venous Thrombosis After Lumbar Puncture and Intravenous High‐Dose Corticosteroids
Author(s) -
Aidi Saadia,
Chaunu MariePierre,
Biousse Valérie,
Bousser MarieGermaine
Publication year - 1999
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1046/j.1526-4610.1999.3908559.x
Subject(s) - medicine , lumbar puncture , anesthesia , venous thrombosis , methylprednisolone , cerebrospinal fluid , thrombosis , intracranial pressure , multiple sclerosis , lumbar , surgery , magnetic resonance imaging , intracranial thrombosis , radiology , psychiatry
Objective.—To emphasize the diagnostic importance of change in the headache pattern which pointed to cerebral venous thrombosis in two patients after lumbar puncture and high‐dose intravenous methylprednisolone for suspected multiple sclerosis. Results.—Both patients had a diagnostic lumbar puncture for suspected multiple sclerosis and were treated with high‐dose intravenous methylprednisolone. Both developed a postlumbar puncture headache that was initially postural, typical of low cerebrospinal fluid pressure. Three days later, the headache became constant, lost its postural component, and was associated with bilateral papilledema. Magnetic resonance imaging of the brain disclosed superior sagittal and lateral sinuses thrombosis. The diagnostic difficulties of such cases and the potential role of lumbar puncture and corticosteroids as risk factors for cerebral venous thrombosis are discussed. Conclusions.—When a typical postdural puncture headache loses its postural component, investigations should be performed to rule out cerebral venous thrombosis, particularly in the presence of other risk factors.