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

2009 ◽  
Vol 27 (5) ◽  
pp. E5 ◽  
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.

scholarly journals Cerebral Venous Sinus Thrombosis: An Uncommon Presentation of Headache Mimicking Subarachnoid Hemorrhage

1970 ◽  
Vol 10 (2) ◽  
pp. 115-118
Author(s):  
Naima Sultana ◽  
Monzurul H Chowdhury ◽  
Md Shahriar Mahbub ◽  
Md Billal Alam
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Oral Contraceptives ◽  
Sinus Thrombosis ◽  
Serum Levels ◽  
Cerebral Venous Sinus Thrombosis ◽  
Sudden Onset ◽  
Interesting Case ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Uncommon Presentation

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

scholarly journals Clinical associations, biological risk factors and outcomes of cerebral venous sinus thrombosis

2016 ◽  
Vol 44 (6) ◽  
pp. 1454-1461 ◽  
Author(s):  
Hafize Nalan Gunes ◽  
Burcu Gokce Cokal ◽  
Selda Keskin Guler ◽  
Tahir Kurtulus Yoldas ◽  
Umit Yavuz Malkan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Common Symptom ◽  
Venous Sinus Thrombosis ◽  
Hospitalization Period ◽  
Wide Range ◽  
Significant Difference ◽  
Clinical Associations

Objective Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease affecting young adults. The majority of the patients are female. The aim of this study is to assess the clinical associations, risk factors and outcomes of the patients with CVST. Methods The data of 75 patients with CVST admitted to our hospital between 2006 and 2016 were reviewed. Demographic and clinical features and the thrombophilic risk factors of the patients were recorded. The localizations of the thrombi were determined and modified Rankin score at the time of onset and discharge were calculated. Results The majority of our patients (78.7%) were female. Median age was 35 years (16–76). The most common symptom was headache (86.7%). In 82.6% of our patients, inherited or acquired risk factors for thrombosis were detected. Transverse sinus was the most common site of thrombosis followed by sigmoid and superior sagittal sinuses. Two thirds of the patients had involvement of multiple sinuses. The patients with the involvement of sagittal sinus had better disability at the time of admittance ( p = 0.013) while the number of involved sinuses was correlated worse disability ( p = 0.015). The neurologic states in the majority of the patients were improved by the end of the hospitalization period ( p = 0.001). There was no significant difference in disability score at discharge between men and women ( p = 0.080). No patient with CVST died in the hospitalization period. Conclusions This study is one of the largest cohort studies on CVST in our region. The results of the study disclosed that CVST had wide range of clinical manifestations and non-specific symptoms at the beginning. For that reason, in especially high risk groups for thrombosis, the diagnosis of CVST should be kept in mind.

scholarly journals A Case of Worsening Deep Cerebral Venous Sinus Thrombosis Managed by Intrasinus Thrombolysis

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Nidhi Sood ◽  
Nikhil Sood ◽  
Arun Talkad
Keyword(s):  
Sinus Thrombosis ◽  
Treatment Options ◽  
Recombinant Tissue Plasminogen Activator ◽  
Diagnostic Techniques ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Cerebral Sinus ◽  
Uncommon Condition ◽  
Radiographic Improvement

Cerebral venous sinus thrombosis (CVST) is an uncommon condition with severe consequences. Although we do not know the exact incidence and prevalence of CVST, it is an important diagnosis. Over the past decade, it has been diagnosed more frequently due to greater awareness and availability of noninvasive diagnostic techniques. Furthermore, routine diagnostic neuroimaging has been used to monitor the clinical progress of these patients, especially in deteriorating cases. In order to decrease morbidity and mortality, an understanding of CVST treatment options is important. Treatment of extensive intracranial venous sinus thrombosis with intrasinus infusion of recombinant tissue plasminogen activator (rt-PA) is relatively controversial as there are no clear guidelines in regards to appropriate therapeutic management. We report a case of successful intrasinus thrombolysis of deep cerebral sinus thrombosis (DCST) resulting in rapid radiographic improvement associated with complete clinical recovery.

scholarly journals ChAdOx1 nCOV-19 vaccine-induced immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis (CVST)

2021 ◽  
Vol 14 (6) ◽  
pp. e243931
Author(s):  
Preethi Suresh ◽  
William Petchey
Keyword(s):  
Sinus Thrombosis ◽  
External Ventricular Drain ◽  
Intravenous Immunoglobulins ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
High Dose ◽  
Venous Sinus Thrombosis ◽  
Decompressive Craniotomy ◽  
Intracranial Pressures ◽  
D Dimer

A 27-year-old fit and well man presented with intermittent headaches associated with eye floaters and vomiting. His symptoms started 48 hours after having the first dose of ChADOx1 nCOV-19 vaccine (Vaxzevria, previously AstraZeneca COVID-19 vaccine; AstraZeneca) and bloods showed raised D-dimer, low platelets and fibrinogen. CT venogram demonstrated significant cerebral venous sinus thrombosis. He was immediately started on intravenous immunoglobulins and dabigatran after liasing with haematologist. The next day, he complained of worsening headache and new homonymous hemianopia. Repeat CT of the head showed an acute parenchymal bleed with subdural extension and was given idarucizumab and high-dose steroids. He had an emergency decompressive craniotomy and external ventricular drain as his intracranial pressures were difficult to control. Despite full medical and surgical management, his intracranial pressures continued to rise and his brain injury was felt to be too devastating and was deemed unsurvivable.

Fatal Cerebral Venous Sinus Thrombosis Associated with the Factor V Leiden Mutation and the Use of Oral Contraceptives

1995 ◽  
Vol 74 (05) ◽  
pp. 1382-1382 ◽  
Author(s):  
Françoise Bridey ◽  
Michel Wolff ◽  
Jean Pierre Laissy ◽  
Véronique Morin ◽  
Martine Lefebvre ◽  
...  
Keyword(s):  
Oral Contraceptives ◽  
Sinus Thrombosis ◽  
Factor V Leiden ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Factor V ◽  
Factor V Leiden Mutation ◽  
Venous Sinus Thrombosis

scholarly journals A Case of Central Venous Sinus Thrombosis in a Young Woman

2019 ◽  
Vol 3 (4) ◽  
pp. 345-348
Author(s):  
Liam Delahanty ◽  
Timothy Parker
Keyword(s):  
Clinical Judgment ◽  
Sinus Thrombosis ◽  
Altered Mental Status ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Common Symptom ◽  
Venous Sinus Thrombosis ◽  
Resource Limited ◽  
Clinical Presentations ◽  
Reasonable Suspicion

Altered mental status is a common symptom in emergency department evaluations and may be present in as many as four to ten percent of patients.1 The etiology can be difficult to determine without significant evidence from laboratory, radiographic and physical examination. The diagnostic approach is largely driven by the provider’s clinical judgment based on the available history. Consequently, less-common diagnoses can be easily missed or delayed if a reasonable suspicion does not exist when considering possible causes. Cerebral venous sinus thrombosis (CVST) is one such uncommon, seldom-considered disease that carries a significant morbidity and mortality. Its clinical presentations vary and it disproportionally affects young to middle-aged individuals. Knowledge of the disease, particularly the risk factors, is key to making the diagnosis. We will discuss the case of a patient who presented with CVST and intraparenchymal hemorrhage in a resource-limited environment.

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