Cerebral venous sinus thrombosis as a complication of a microendoscopic discectomy.

cranial hypotension due to a CSF leak was suspected, and bed rest, prophylactic lowmolecular-weight heparin, intravenous rehydration and symptomatic antiemetic and analgesic therapy with metoclopramide and paracetamol were prescribed. On the 2nd hospital day, postural headaches worsened with frequent vomiting. Further laboratory tests on the 3rd hospital day remained unremarkable, with Creactive protein returning to normal. Neurological focus or signs of meningitis did not develop but the headaches became non-postural. As intracranial hypotension syndrome became unlikely, a CT scan of the brain was performed on the 6th hospital day. A 6-cm-long filling defect was detected in the left superior sagittal sinus, corresponding to a cerebral venous sinus thrombosis (CVST; fig. 1 a). A subsequent contrast-enhanced MRI demonstrated unspecific and discrete meningeal enhancement on the T 1 -weighted scans. CVST was confirmed, and there was no evidence for a venous infarction ( fig. 1 b). Upon detailed inquiry, a history of an earlier anterior spinal artery thrombosis was mentioned in the patient’s younger brother. A workup for thrombophilia identified the patient as heterozygous for Dear Sir, An 18-year-old woman was referred to the local hospital by her primary care physician because of severe nausea accompanied by bifrontal headaches and photophobia. Three days prior to admission, she had undergone microendoscopic discectomy (MED) at the level L 5 /S 1 for subligamentous left paramedian disc hernia. The procedure was performed under spinal anesthesia with no intraoperative complications. Postoperative mobilization was normal, and the patient was discharged in good health on the 2nd postoperative day. Increasing headache developed shortly after returning home, and the patient was then referred to this hospital. On admission, she complained of severe bifrontal headache that was worse when she was upright, nausea and photophobia. The patient was overweight (BMI of 28.3). There were no signs of optical disc swelling, elevated blood pressure or focal neurologic deficit besides dysesthesia on the lateral edge of the left foot interpreted as residual sign following disc herniation. Routine laboratory analyses were normal apart from a slightly elevated C-reactive protein at 10 mg/l (normal value ! 5 mg/l). IntraReceived: October 27, 2010 Accepted: December 1, 2010 Published online: January 20, 2011