Abstract
Dear Sir Ferrante reports a case of cerebral venous thrombosis (CVT) with cortical haemorrhage after development of post-dural puncture headache (PDPH). The patient had no risk factors for CVT apart from two epidural injections with probable accidental dural puncture leading to intracranial hypotension and venodilation. Epidural blood patch (EBP) therapy was performed with excellent response to headache.
In contrast to this case, we reported on a female patient who developed CVT after EBP was performed. The patient had several risk factors for CVT (puerperal state, heterozygous factor V mutation, PDPH). Review of literature revealed five further cases in whom CVT developed after EBP treatment for PDPH. All patients were in the puerperal state.
We agree with Ferrante that CVT in our patient may have been caused by the underlying established risk factors. Nevertheless, the close temporal relationship of EBP and development of CVT in our and other patients described in the case report is striking. Although a pathophysiological link between EBP and CVT is hard to establish, CVT should be excluded in patients with headache relapse (without postural relief) or new onset of neurological signs after EBP.
As suggested by Ferrante, a documented case of CVT following EBP in absence of further risk factors can be helpful to implicate a causal relationship between EBP and CVT.