Cerebral venous thrombosis after lumbar puncture and high steroid cycle in a patient with multiple sclerosis

The present case report underlies the importance of modifications in the characteristics of post-lumbar puncture headache, which led us to diagnose cerebral venous thrombosis in a 34-year-old woman affected by multiple sclerosis. The patient underwent a lumbar puncture for diagnostic purposes and successively was treated with megadoses of methylprednisolone (1 g intravenously for 6 days). After lumbar puncture, the patient developed an orthostatic headache sue to cerebrospinal fluid (CSF) hypotension. Eight days later, and two days after finishing the cycle of methylprednisolone, the headache worsened, became diffuse and persisting, and was longer modified by postural changes. This was associated with psychomotor slowing and, the day after, a partial epileptic status. Magnetic resonance imaging showed an alteration in the signal corresponding to the sagittal superior, transverse and sigmoid sinuses, indicative of venous thrombosis. The potential role of lumbar puncture, steroid treatment and other associated risk factors, and the importance of considering modifications in post-puncture headache as a condition which needs specific neuroradiological examinations are discussed.