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。临床最常考虑的致病因素包括子痫、脑静脉血栓形成、可逆性血管收缩综合征以及后部可逆性脑病综合征（posterior reversible encephalopathy syndrome, PRES）。当痫性发作伴随运动功能缺损等神经功能缺损症状时，脑血管疾病（尤其是脑静脉血栓形成）会成为更需重点考量的诊断方向。对于有脊髓麻醉史的产后患者，颅内低压症（intracranial hypotension, ICH）也应纳入病因考量范畴[1]。
颅内低压症（intracranial hypotension, ICH）是一种易与多种头痛类型混淆的疾病，可伴发硬膜下积液（subdural effusion, SDE）、蛛网膜下腔出血（subarachnoid hemorrhage, SAH）、颅神经病变以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关键参考价值[3]。在本病例中，由于痫性发作后出现发作后意识模糊，体位性头痛的病史采集被延后。此外，患者入院时的弥散加权磁共振成像（diffusion-weighted magnetic resonance imaging, MRI）可见符合脑血管病变的异常病灶，因此最初怀疑为窦静脉血栓形成（sinus venous thrombosis, SVT）。但经详细的病史采集后，最终确诊为颅内低压症。随访期间，同时观察到了硬膜下积液与蛛网膜下腔出血两种并发症。