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Cortical Vein Thrombosis May Mimic Postdural Puncture Headache
  1. Eric C. Gewirtz, MD,
  2. Melania Costin, MD and
  3. Gertie F. Marx, MD
  1. From the Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York


Two case histories are presented of postpartum women whose postdural headache, presumed to result from dural puncture, was treated with epidural blood patch, but was eventually diagnosed as a symptom of cortical vein thrombosis. Although the headaches associated with cerebral phlebothrombosis and those due to dural puncture are difficult to differentiate, there appear to be subtle differences. With phlebothrombosis, the headaches are intensely throbbing, increasing in intensity, and frequently accompanied by sweating, nausea, and vomiting. This combination of symptoms warrants exclusion of venous thrombosis by radiography before an epidural blood patch is placed.

  • Postural headache
  • Dural puncture
  • Cerebral phlebothrombosis
  • Epidural blood patch

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