Question
A 39-year-old woman on OCPs presents with headache for 2 days and paraparesis. The most likely cause is _______
| A. |
Posterior reversible encephalopathy syndrome
|
| B. |
Cerebral venous thrombosis
|
| C. |
Complicated migraine
|
| D. |
Subarachnoid hemorrhage
|
Show Answer
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Correct Answer � B
Explanation
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|
Ans. B. Cerebral venous thrombosis
The symptoms described above along with the history of OCP use suggest cerebral venous thrombosis.
Cerebral venous thrombosis (CVT) is the thrombosis of venous channels in the brain. It is an uncommon cause of cerebral infarction.
Risk factors of CVT:
Oral contraceptive use
Pregnancy and puerperium
Inflammatory bowel disease
Intracranial infections (meningitis)
Dehydration
Prothrombotic conditions
Symptoms:
Headache: Most common
Seizures
Intracranial Hypertension
Focal neurological Deficits
Altered Mental status
Diagnosis: MR Venography: most useful technique.
The signs on CT are as follows:
Empty Delta Sign
Dense Triangle Sign
Cord Sign
Treatment:
Acute treatment: IV Heparin or LMWH
Warfarin for at least 3 months. Target INR: 2.5 (2 to 3)
Pregnant women with a history of CVT: anticoagulation with LMWH throughout pregnancy and till 8 weeks postpartum.
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