A 30-year-old woman presented with sudden position-independent severe headache and neck pain 2 weeks postpartum. Standard magnetic resonance imaging revealed ipsilateral dural thickening and enhancement of the meninges (left hemisphere). The symptoms and findings were interpreted as a post-lumbar puncture syndrome associated with the epidural anesthesia during labor and birth. Deteriorating, the patient was referred to our hospital after a computed tomography scan had revealed atypical left parietal intracranial hemorrhage. Digital cerebral subtraction angiography confirmed a left parietal ICVT as the underlying disease. When systemic anticoagulation was initiated, the patient's condition further deteriorated. Progressive aphasia and right-sided face and arm weakness and numbness developed as a result of increased intracranial hemorrhage volume. We therefore performed craniotomy and hematoma evacuation, after which the patient fully recovered.
We hypothesize that ipsilateral dural thickening and enhancement in patients presenting with severe headache may indicate ICVT and we suggest further diagnostic workup, using venographic study such as computed tomographic venography or magnetic resonance venography. In an inconclusive venographic study with high clinical suspicion for ICVT, catheter cerebral angiography is indicated.