RT Journal Article SR Electronic T1 Dural puncture and activated protein C resistance: risk factors for cerebral venous sinus thrombosis JF Journal of Neurology, Neurosurgery & Psychiatry JO J Neurol Neurosurg Psychiatry FD BMJ Publishing Group Ltd SP 351 OP 356 DO 10.1136/jnnp.63.3.351 VO 63 IS 3 A1 Einar Wilder-Smith A1 Ingrid Kothbauer-Margreiter A1 Bernhard Lämmle A1 Matthias Sturzenegger A1 Christoph Ozdoba A1 Simon P Hauser YR 1997 UL http://jnnp.bmj.com/content/63/3/351.abstract AB OBJECTIVES Dural puncture is regarded a safe procedure when contraindications are carefully excluded and has so far not been recognised as a risk factor for cerebral venous sinus thrombosis (CVST). Five patients are described with CVST after dural puncture in the presence of additional risk factors. METHODS In four out of five patients complete investigations for thrombophilia were performed at least one month after withdrawal of oral anticoagulation. RESULTS In three out of four patients tested, activated protein C (APC) resistance due to heterozygous coagulation factor V R506Q mutation (factor V Leiden) was found. One patient was using oral contraceptives as a circumstantial risk factor and three had had spinal anaesthesia for surgical procedures. Family history of venous thromboembolism was negative in all patients. Retrospective evaluation of 66 patients with CVST disclosed that dural puncture was the fourth most common risk factor (8%) possibly contributing to thrombosis. CONCLUSION Dural puncture may constitute an additional risk factor for CVST especially in patients with APC resistance or surgery. In such patients a thrombophilia screen is indicated.