Intracranial Hypotension Signs Missed on Initial MRI in Postpartum CVT Patients with Spinal CSF Leaks

In four postpartum patients with cerebral venous thrombosis (CVT) after epidural anesthesia, all had coexisting spinal CSF leaks, and imaging signs of intracranial hypotension were present on initial brain MRI but overlooked in every case.

• Epidural blood patching led to rapid clinical improvement and resolution of hypotension findings, while CVT resolved with anticoagulation.
• Radiologists should evaluate for both CVT and intracranial hypotension in postpartum headache to avoid premature diagnostic closure.

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