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Case Reports
. 2019 Aug;98(33):e16440.
doi: 10.1097/MD.0000000000016440.

A case report of oral contraceptive misuse induced cerebral venous sinus thrombosis and dural arteriovenous fistula

Qingling Huang  1 , Xue Chai  1 , Chaoyong Xiao  1 , Xuan Cao  2
Affiliations
Case Reports

A case report of oral contraceptive misuse induced cerebral venous sinus thrombosis and dural arteriovenous fistula

Qingling Huang et al. Medicine (Baltimore). 2019 Aug.

Abstract

Rationale: Consumption of oral contraceptive pills (OCP) is a known risk factor for cerebral venous sinus thrombosis (CVST) among women. Development of dural arteriovenous fistula (dAVF) afterwards was very uncommon. We present a rare chronic complication of development of dAVF after CVST.

Patient concerns: A 22-year-old woman suffered headache for a week. She was then admitted into our hospital.

Diagnosis: Contrast enhanced magnetic resonance venography (MRV) demonstrated the thrombosis of the left transverse-sigmoid sinus the second day.

Interventions: The intravenous thrombolysis was carried out. As the symptoms improved, the patient was discharged, while the treatment with oral dabigatran continued. However, 3 months after the onset, magnetic resonance imaging (MRI) showed swelling brainstem, and digital subtraction angiography (DSA) confirmed a dAVF. Clipping of the fistula was conducted, and her clinical symptoms improved gradually.

Outcomes: The patient was transferred to rehabilitation center later, and received follow-up care.

Lessons: When a patient taking OCP and suffering from a sudden headache, a clinical suspicion of possible CVST should always arise to avoid the onset of dAVF as soon as possible.

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Conflict of interest statement

The authors have no conflicts of interests to disclose.

Figures

Figure 1
Figure 1
The head unenhanced CT scanning of a 22-year-old woman showed scattered minor hemorrhages in the left temporal lobe.
Figure 2
Figure 2
Focal bleeding-infarction and edema on axial T2 magnetic resonance image (MRI).
Figure 3
Figure 3
The thrombosis of the left transverse-sigmoid sinus on T1WI after contrast injection.
Figure 4
Figure 4
Cerebral magnetic resonance venography (MRV) demonstrated left transverse-sigmoid sinus thrombosed and the left sinus was smaller than the right.
Figure 5
Figure 5
Axial T2 magnetic resonance image (MRI) showed focal subcortical hypointensity in the left temporal lobe a month later.
Figure 6
Figure 6
Axial T2 magnetic resonance (MRI) showed focal T2 hypointensity in brain stem and left cerebellar hemisphere 3 months later.
Figure 7
Figure 7
Corresponding contrast-enhanced image of the brain stem and left cerebellar hemisphere.
Figure 8
Figure 8
digital subtraction angiography (DSA) confirmed a dural arteriovenous fistula (dAVF) of the left sigmoid sinus supplied by dural branches of the left occipital and right middle meningeal artery.
Figure 9
Figure 9
Clipping of the fistula was conducted. The left sigmoid sinus was still not patent.
See this image and copyright information in PMC

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