Recurrent Syncope Due to Refractory Cerebral Venous Sinus Thrombosis and Transient Elevations of Intracranial Pressure

摘要

Chronic paroxysmal intracranial hypertension leading to syncope is a phenomenon not reported previously in patients with refractory cerebral venous sinus thrombosis. We report a case of paroxysmal intracranial hypertension leading to syncopal episodes in a patient with idiopathic autoimmune hemolytic anemia and venous sinus thrombosis. This case demonstrates that intermittent elevations in intracranial pressure can lead to syncope in patients with venous sinus thrombosis and emphasizes the importance of considering this potentially treatable etiology of syncopal episodes.Transient elevations in intracranial pressure (ICP) are well-studied phenomena in the brain-injured patient, but less is known about their presence in healthy patients and also in patients with idiopathic intracranial hypertension (IIH). We present here the case of a 36-year-old woman with frequent syncopal episodes in the setting of ICP spikes to >60 mm Hg. In the setting of a cerebral venous sinus thrombosis (CVST), the patient developed elevated ICPs with a likely shift of cerebral autoregulation to the passive reactivity range and resultant Lundberg A waves on ICP monitoring. This represents a rare consequence of refractory CVST that is amenable to treatment with ventriculoperitoneal shunt.