Acute cerebral venous thrombosis in the setting of spontaneous intracranial hypotension during the postpartum period: A case report

Introduction: Cerebral venous thrombosis (CVT) is a rare, life-threatening complication of spontaneous intracranial hypotension (SIH). According to the Monro-Kellie doctrine, CSF depletion triggers compensatory venous dilatation and stasis, which, in prothrombotic states, facilitates thrombus formation. This report describes CVT secondary to SIH during the postpartum period. Case presentation: A 31-year-old postpartum woman presented with an orthostatic headache, neck pain, and photophobia. Brain MRI demonstrated pachymeningeal enhancement and cerebellar tonsillar descent, while MRV confirmed extensive CVT. Spinal imaging identified a CSF leak at C7–C8. The patient received systemic anticoagulation without an epidural blood patch, achieving complete clinical recovery and radiological recanalization at six months. Discussion: The synergy between mechanical venous distension from SIH and postpartum hypercoagulability precipitates CVT. This association is often underdiagnosed because the acute symptoms of venous thrombosis can mask the underlying intracranial hypotension. Conclusions: Maintaining a high index of suspicion for CVT in patients with SIH—especially when headache semiology changes—is crucial. Early recognition allows for integrated management and prevents permanent neurological deficits.