Aggressive treatment of severe acute cerebral venous thrombosis associated with oral contraceptives in young women

Abstract

The use of oral contraceptives is a known risk factor for cerebral venous thrombosis. This diagnosis may be difficult but should always be considered because of the possible serious consequences if left untreated. Radiological and nuclear magnetic resonance imaging, and cerebral angiography make the diagnosis possible. There is no well-established therapy for this syndrome. Heparin administration is controversial but there is increasing evidence that the presence of intracranial haemorrhage is not a strict contraindication and that anticoagulation achieves the best results.Two cases of severe acute cerebral venous thrombosis in young women taking the contraceptive pill are reported. Following clinical and radiological diagnosis, and worsening of their condition, they were admitted to the ICU and treated aggressively with barbiturate-induced coma, mechanical ventilation, anticoagulants and thrombolytics, and osmotherapy when necessary. Haemorrhagic complications were not observed. On discharge from the hospital and after two years' follow-up, both patients have made a complete clinical recovery.