Intracranial Hypotension and Bilateral Isolated Cortical Vein Thrombosis: A Case Report and Literature Review

Abstract

Background: Intracranial hypotension (IH) is a clinical manifestation of low cerebrospinal fluid pressure with reports of isolated cortical venous thrombosis (ICVT) rarely described. Case Presentation: A 23-year-old man presented with postural headache followed by blurry vision and horizontal binocular diplopia with extreme gaze. Patient workup showed diffuse thickening and enhancement of the dura suggestive of intracranial hypotension and biparietal superficial cortical vein thrombosis was noted on imaging. The patient was started on folate and therapeutic anticoagulation and his condition improved. Conclusion: Patients with IH are at risk for CVT due to the dilation of the venous sinuses of the brain. Changes in the characteristics of the headache of the patient or the onset of new neurological symptoms should warrant further investigation. Prophylactic systemic anticoagulation might cautiously be indicated in high-risk patients with IH to prevent ICVT.