Dural venous sinus thrombosis following myelography: demonstration by magnetic resonance imaging

Abstract

Headache is a common complication of myelography, occurring in approximately 30% of cases (Wilkinson & Sellar, 1991). The headaches may be severe and are frequently postural in nature. We present a case in which a severe post-myelographic headache progressed over a period of six weeks. The development of fundal haemorrhages with visual impairment prompted investigation by magnetic resonance imaging (MRI) which demonstrated thrombosis of the right transverse sinus. Anticoagulant therapy led to prompt relief of symptoms and improvement of visual acuity. A 51-year-old man presented to another hospital with three days of severe low back pain and right-sided sciatica. Initial examination demonstrated reduced straight leg raising on the right but no other abnormality. Initial treatment with seven days bed rest resulted in no improvement and a lumbar myelogram was performed using iohexol (Omnipaque, 240mg/ml, Nycomed Ltd). Myelography demonstrated no evidence of significant abnormality and the patient's symptoms resolved spontaneously.