Rare case of simultaneous cerebral artery and venous sinus thrombosis in the setting of elevated factor VIII and combined oral contraceptive pills

Abstract

We report a rare case of combined cerebral venous sinus thrombosis and ischemic stroke in a 35-year-old female on combined oral contraceptive pills (COCPs) with persistently elevated factor VIII, presenting with headache and sudden onset vertigo, found to have extensive cerebral venous sinus thrombosis and PICA territory ischemic infarct.

Keywords: cerebral venous sinus thrombosis; factor VIII; ischemic stroke.

FIGURE 1

(A‐D) Plain‐ none enhanced CT head and CTV. (A, B) Left temporo‐occipital intraparenchymal hemorrhage with surrounding edema and adjacent mass effect evident by effacement of the adjacent cortical sulci. A cord like hypodensity noted in the left transverse sinus [white arrow]. (C, D) Filling defect involving the left transverse (yellow arrow) and left sigmoid sinuses extending to the left jugular vein. Left vein of Labbe is also not visualized [white arrows]

FIGURE 2

(A‐F) MRI/MRV/MRA head. (A, B) There is diffusion restricting (Blue arrow) and slightly FLAIR hyperintense acute infarcts in the left postero‐inferior cerebellar hemisphere (Green arrow). (C, D) SWI shows blooming in the left temporo‐occipital suggestive of venous hypertension with hemorrhage, with surrounding edema evident on FLAIR hyperintense (Orange arrow). (E, F) MRA, show occlusion of intracranial V4 and skull base V3 segments of the left vertebral artery (Red arrow). MR venogram shows that there is interval near total recanalization of the left sigmoid sinus, partial recanalization of the left internal jugular vein and significant amount of residual clot in the left transverse sinus medially with recanalization of only its lateral aspect (Yellow arrows)