Spontaneous Intracranial Hypotension Discovered Following Cerebral Venous Thrombosis: A Case Report and Review of the Literature

Cerebral venous thrombosis (CVT) is a rare complication of spontaneous intracranial hypotension (SIH). We encountered a case where SIH was discovered after the diagnosis of CVT, suggesting the occurrence of CVT during the acute phase of SIH. We report this rare case of isolated cortical vein thrombosis in the acute phase of SIH. A 48-year-old woman taking low-dose oral contraceptives presented with neck pain, headache, and right-sided weakness. Magnetic resonance imaging and digital subtraction angiography confirmed isolated cortical vein thrombosis. No other specific imaging abnormalities were noted. The patient was initially treated with anticoagulation. Subsequent worsening of her orthostatic headache led to the diagnosis of SIH, with diffuse dural enhancement on gadolinium-enhanced T1-weighted imaging. An epidural blood patch was performed, resulting in a favorable outcome with no neurological deficits. Although CVT can occur in the acute phase of SIH, particularly in patients with thrombophilia, the lack of characteristic imaging findings associated with SIH often complicates the diagnosis.