INTRACRANIAL HYPOTENSION MIMICKING CEREBRAL VENOUS INFARCTION

Postpartum seizures can be attributed to various etiological factors. The most common conditions that come to mind include eclampsia, cerebral venous thrombosis, reversible vasoconstriction syndrome, and posterior reversible encephalopathy syndrome (PRES). Especially when neurological defects like motor deficits accompany an epileptic seizure, cerebrovascular diseases, particularly cerebral venous thrombosis, become more prominent. In postpartum patients with a history of spinal anesthesia, intracranial hypotension (ICH) should also be considered in the etiology (1).
Intracranial hypotension (ICH) is a condition that can be confused with many types of headaches and is associated with various complications such as subdural effusion (SDE), subarachnoid hemorrhage (SAH), cranial neuropathy, and epileptic seizures (2,3). Postural headache is particularly significant for diagnosis (3). In our case, due to the postictal confusion following the epileptic seizure, the anamnesis of the postural headache was taken later. Moreover, an initial suspicion of sinus venous thrombosis (SVT) arose due to lesions observed in hospital admission diffusion-weighted magnetic resonance imaging (MRI) consistent with a cerebrovascular pathology. However, after a detailed anamnesis, an ICH diagnosis was made. During follow-up, both subdural effusion and subarachnoid hemorrhage complications were observed concurrently.

产后痫性发作可由多种病因学因素引发。临床常见的可疑病因包括子痫、脑静脉血栓形成、可逆性血管收缩综合征及后部可逆性脑病综合征（PRES）。当痫性发作伴随运动功能缺损等神经功能缺损表现时，脑血管疾病（尤其是脑静脉血栓形成）的嫌疑度显著升高。对于存在脊髓麻醉史的产后患者，颅内低压症（ICH）也应纳入病因鉴别范畴（1）。

颅内低压症（ICH）是一种易与多种头痛疾病混淆的病症，可伴随硬膜下积液（SDE）、蛛网膜下腔出血（SAH）、颅神经病变及痫性发作等多种并发症（2,3）。体位性头痛对该病的诊断具有重要参考意义（3）。在本次病例中，由于痫性发作后出现发作后意识模糊，体位性头痛的相关病史后续才得以采集。此外，患者入院时的弥散加权磁共振成像（MRI）可见符合脑血管病变的异常信号，因此最初曾怀疑为静脉窦血栓形成（SVT）。但经详细的病史问询与梳理后，最终确诊为颅内低压症。随访期间，患者同时出现了硬膜下积液与蛛网膜下腔出血两种并发症。