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Neurology
Cerebral venous sinus thrombosis after intrathecal administration of nusinersen
  1. Aicee Dawn Calma1,
  2. Irene Tan2,
  3. Ibrahim Tohidi-Esfahani3,
  4. Lauren Sanders4,5,
  5. Kishore Kumar1,6 and
  6. Katrina Morris1,6
  1. 1 Neurosciences, Concord Repatriation General Hospital, Concord West, New South Wales, Australia
  2. 2 Radiology, Concord Repatriation General Hospital, Concord West, New South Wales, Australia
  3. 3 Haematology, Concord Repatriation General Hospital, Concord West, New South Wales, Australia
  4. 4 Neurology and Neurosciences, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
  5. 5 The University of Melbourne St Vincent's Department of Medicine, Melbourne, Victoria, Australia
  6. 6 The University of Sydney Concord Clinical School, Concord West, New South Wales, Australia
  1. Correspondence to Dr Katrina Morris; K.morris{at}sydney.edu.au

Abstract

Cerebral venous sinus thrombosis is an uncommon sequela of low intracranial pressure, which may result from a lumbar puncture (LP). We describe a case of a patient in their 40s presenting with 48 hours of persistent headache following intrathecal administration of nusinersen for spinal muscular atrophy (SMA) type 3. There were no focal neurological signs or symptoms apart from baseline symmetrical proximal limb weakness attributed to SMA. Initial investigations revealed radiological evidence of an acute cerebral venous sinus thrombus (CVST). The patient was promptly started on anticoagulation. Partial recanalisation was seen as soon as 48 hours after commencement of anticoagulation, with almost full resolution of the thrombus at follow-up in 2 months. Awareness of CVST as a potential complication of intrathecal therapies and diagnostic LP allows for early identification, management and prevention of serious neurological consequences.

  • Stroke
  • Headache (including migraines)
  • Neuroimaging
  • Neuromuscular disease

https://doi.org/10.1136/bcr-2024-260080

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: ADC, IT, IT-E, KK, LS and KM. The following authors gave final approval of the manuscript: ADC, IT, IT-E, KK, LS and KM. KM accepts full responsibility for the finished work and/or the conduct of the study, had access to the data and controlled the decision to publish. KMorris acts as a guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests KK received grants from Medical Research Future Fund and Paul Ainsworth Family Foundation. KKumar received honoraria for delivering lectures at the International Parkinson and Movement Disorder Society.

    • Provenance and peer review Not commissioned; externally peer reviewed.