Cerebral venous sinus thrombosis due to desogestrel intake in a young lady: A case report

Abstract

Cerebral Venous Sinus Thrombosis (CVST) is a subtype of venous thromboembolism, which occurs in the dural venous sinuses. Blockage of the venous drainage of the brain leads to the development of hemorrhages. Strokes can hence develop in any individual, irrespective of age or sex. CVST is a very serious condition requiring immediate thrombolysis to prevent residual neurological deficits. We report the case of a lady aged 25 years, who presented to the emergency department with a severe diffuse headache for 4 days, associated with vomiting. This was followed by multiple episodes of seizures and altered sensorium the previous day. She had been taking desogestrel for the past 2 months. On examination, the patient was unconscious and febrile (102.8 F). On admission, Glasgow Coma Scale score of E2V2M3 and bilateral extensor plantar response were noted. Signs of meningeal irritation were absent. Her pupils were mid-dilated, sluggishly reactive to light, and papilledema was present bilaterally. Based on imaging studies, she was diagnosed with a case of CVST. Her homocysteine levels were elevated. She recovered on appropriate treatment and was discharged on Ryle's feeding tube after 26 days of hospital stay with a Glasgow Coma Scale score of E4V5M6 and a flexor plantar response. The case emphasizes the need to rule out CVST in young adult females on oral contraceptive pills (OCP) presenting with severe neurological dysfunction. Vigilant screening, clinical suspicion and timely management can help cut down the associated mortality and morbidity in such cases.

Keywords: Desogestrel; Oral contraceptive pills; cerebral venous sinus thrombosis; hyper‐homocysteinemia; progesterone only pills.

FIGURE 1

Dense delta sign visualized in non‐contrast enhanced CT of the patient; signifying sagittal sinus thrombosis.

FIGURE 2

MRI showing superior sagittal sinus thrombosis as evidenced by the hyperintensity shown by the yellow arrow; hemorrhagic transformation (shown by the green arrow).

FIGURE 3

MRI showing the hemorrhagic transformations (shown by the green arrows).