Cerebral Venous Sinus Thrombosis With Ophthalmic Manifestations in 18-Year-Olds on Oral Contraceptives

Cerebral venous sinus thrombosis is a rare disorder accounting for less than 1% of all strokes. It is more common in children and young adults. Here we report a rare and interesting case of cerebral venous l sinus thrombosis mimicking subarachnoid hemorrhage. A 40 years old women, presented with sudden onset of headache, vomiting and unconsciousness associated with convulsions. She had a history of taking oral contraceptives for the last 12 years. Clinical examinations showed ill-looking women with Glasgow Coma Scale of 12 along with neck rigidity and bilateral papilloedema. Although initially we suspected her as a case of subarachnoid hemorrhage, subsequent investigations with MRI and MRV showed to be a case of superior sagittal and transverse sinus thrombosis. Treatment with anticoagulation recovered her from headache and papilloedema. Serum levels of thrombophilic factors were within the normal physiological limits. Thus we concluded that although cerebral venous thrombosis is 100 times less than the cerebral arterial disease, a women presented with sudden onset of headache and vomiting with long term use of oral contraceptives, cerebral thrombosis should be considered as a differential. Key words: Cerebral venous sinus thrombosis , Sagittal sinus thrombosis, Subarachnoid hemorrhage , Magnetic resonance venography. doi: 10.3329/jom.v10i2.2826 J MEDICINE 2009; 10 : 115-118

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Cerebral venous sinus thrombosis associated with oral contraceptives: the case for neurosurgery

Neurosurgical FOCUS ◽

10.3171/2009.8.focus09158 ◽

2009 ◽

Vol 27 (5) ◽

pp. E5 ◽

Cited By ~ 10

Author(s):

Marcelo Galarza ◽

Roberto Gazzeri

Keyword(s):

Genetic Analysis ◽

Oral Contraceptives ◽

Young Women ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Common Symptom ◽

Venous Sinus Thrombosis ◽

Decompressive Craniotomy ◽

Cerebral Sinus

Object The goal of this study was to provide data about neurosurgical management of cerebral venous sinus thrombosis in young women after use of oral contraceptives. Methods Between 1990 and 2007, the authors treated 15 women (age range 23–45 years) in whom neurosurgical management was used for overt thrombosis of cerebral sinus. All were healthy, with a history of use of oral contraceptives. Severe headache was the most common symptom, followed by motor focal deficits and comatose state. Deep infarcts were located in the thalamic and basal ganglia region in 11 cases. Seven women had associated intracerebral hemorrhage, and 3 had ventricular dilation. Angiographic MR imaging was done in 10 patients, and conventional angiography was done in 7. Genetic analysis of chromosomal abnormalities associated with stroke was done in 5 cases. Results The intracranial pressure (ICP) was monitored in all cases. Three patients underwent external ventricular drainage, and 1 had a decompressive craniotomy. All had absence of signal in the cerebral sinus rectus, with associated thrombosis of the transverse sinus in 7 cases. Angiograms were negative for additional vascular malformation. Medical treatment included sodium heparin and mannitol in 9 cases, and enoxaparin in the other 6 patients. Genetic analysis was positive for prothrombin mutation G20210A (factor II variant) in 2 cases. The mean follow-up duration of 53 months demonstrated no neurological deficit in 10 patients, hemiparesis in 3, and severe hemiparesis with aphasia in 1 case. One woman died 5 days after a decompressive craniotomy. Conclusions Cerebral venous sinus thrombosis secondary to oral contraception in young women, including lesions in critical and deep regions, can be treated medically with acceptable morbidity. In spite of this, a subgroup of patients needed basic neurosurgical management of the lesions, including surgical measures for controlling raised ICP.

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