Open AccessParadoxical presentation of orthostatic headache associated with increased intracranial pressure in patients with cerebral venous thrombosis
Author(s) -
Jung B. Kim,
Do Young Kwon,
Moon Ho Park,
Kun Woo Park
Publication year - 2013
Publication title -
annals of indian academy of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.427
H-Index - 31
eISSN - 1998-3549
pISSN - 0972-2327
DOI - 10.4103/0972-2327.107705
Subject(s) - medicine , headaches , orthostatic vital signs , intracranial hypotension , intracranial pressure , venous thrombosis , anesthesia , cerebrospinal fluid , magnetic resonance imaging , presentation (obstetrics) , thrombosis , acetazolamide , radiology , surgery , blood pressure
Headache is the most common symptom of cerebral venous thrombosis (CVT); however, the detailed underlying mechanisms and characteristics of headache in CVT have not been well described. Here, we report two cases of CVT whose primary and lasting presentation was orthostatic headache, suggestive of decreased intracranial pressure. Contrary to our expectations, the headaches were associated with elevated cerebrospinal fluid (CSF) pressure. Magnetic resonance imaging and magnetic resonance venography showed characteristic voiding defects consistent with CVT. We suggest that orthostatic headache can be developed in a condition of decreased intracranial CSF volume in both intracranial hypotensive and intracranial hypertensive states. In these cases, orthostatic headache in CVT might be caused by decreased intracranial CSF volume that leads to the inferior displacement of the brain and traction on pain-sensitive intracranial vessels, despite increased CSF pressure on measurement. CVT should be considered in the differential diagnosis when a patient complains of orthostatic headache.