Contraceptive-Related Cerebral Venous Thrombosis With Profuse Vaginal Bleed

Narayanan, T. Jayashree; Chowdary, Gogineni Vivek; Murthy, J. M. K.

doi:10.1385/ncc:2:3:292

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…Even after full investigations in 20 to 30%, the cause remains uncertain. 2 Puerperium remains an important cause of CVT in developing countries. Among drugs associated with occurrence of CVT, 3 OCPs are the most common.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Venous Thrombosis following Oral Contraceptive Pill Use for Menorrhagia: Management Dilemma

Mehta¹,

Naga²,

Pushpalatha³

2015

JSAFOMS

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Women on oral hormonal therapy for menorrhagia are at risk of cerebral venous thrombosis (CVT). This condition is charac terized by intravascular clotting in the venous system of brain. In this case which is being presented for its rarity, the patient developed CVT following use of low dose estrogen proges terone combination pill; hence, treatment was stopped. Withdrawal of oral contraceptive pill (OCP) was associated with profuse vaginal bleed. Emergency hysterectomy was risky as patient was unstable. Levonorgestrel intrauterine system (LNGIUS) proved to be a safe effective innovative option in this situation.

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Section: Discussionmentioning

confidence: 99%

Cerebral Venous Thrombosis following Oral Contraceptive Pill Use for Menorrhagia: Management Dilemma

Mehta¹,

Naga²,

Pushpalatha³

2015

JSAFOMS

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“…A careful evaluation of complex signs and symptoms not completely explained by the endocrinological diagnosis, and the exhaustive discussion among different consultants (endocrinologists, neurosurgeons, ophthalmologists, and neuroradiologists) disclosed the severe scenario of an associated cerebral venous thrombosis. The possible setting was thrombophilia related to estroprogestative use, as thromboembolic events represent a serious complication of these agents; this phenomenon more frequently involves the lower limb, and only a few cases of cerebral venous thrombosis have been described [1][2][3][4][5][6][7]. A less commonly involved though well described cofactor for thrombophilia was hyperprolactinemia.…”

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confidence: 99%

Unusual association of a pituitary adenoma and a neurological emergency: case report and diagnostic steps

et al. 2008

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A 44-year-old female patient was admitted to the Emergency Department with a 2-day complaint of severe headache in the left frontal region. Her menstrual and pathological history was uneventful. Since 25 years she had been suffering from recurrent headache episodes with vomiting; in the last few years she had been taking oral estroprogestin contraceptives, with a concomitant symptom relief regarding frequency and severity. The latest attack had begun insidiously and was described as not different from the usual pattern; no features suggesting raised intracranial pressure, such as worsening at night or with the recumbent position, were reported. Incidentally, the patient reported the recent appearance of galactorrhea and discovery of elevated PRL serum concentrations (3,952 pmol/L, n.v.\1,100 pmol/L = 24.2 ng/mL). Finding on emergency computerized tomography (CT) imaging was a roundish isodense sellar mass; a presumptive diagnosis of pituitary adenoma was made.The patient was admitted to our Department of Internal Medicine. She appeared alert and attentive, orientated but suffering from intense pulsatile headache with nausea, only temporarily relieved by tramadole and ketorolac i.v. The endocrinological work-up disclosed serum PRL levels 2,486 pmol/L and undetectable gonadotropins compatible with the assumption of estroprogestin pill, stopped at admission; the patient was not assuming other drugs potentially responsible of hyperprolactinemia. The possibility of artifactually low values due to the ''hook effect'' was excluded using a 1:100 dilution of serum; the search for macroprolactinemia yielded negative results. Thyroid function was normal (TSH 2 mU/L; free thyroxine 14 pmol/L; free triiodothyronine 4.8 pmol/L) as well as corticotropin plasma concentration (4.8 pmol/L) and adrenal response to a low-dose ACTH test (1 lg), with cortisol concentration 364 nmol/L in basal conditions and 588 nmol/L after stimulation.The neurological examination did not show evidence of focal deficits or nuchal rigidity; speech was normal, tendon reflexes were symmetric and the plantar reflex was bilaterally in flexion. Fundus oculi examination revealed papilledema. Chest and abdominal examination was unremarkable.Contrast enhancement magnetic resonance imaging (MRI) of the sellar region (Fig. 1) showed a large wellcircumscribed dumbbell-shaped sellar and suprasellar mass, which involved the pituitary gland, dislocated the infundibular stalk on the left, abutted the optic chiasm and eroded into the sphenoid sinus. Hypothesizing a macroprolactinoma, a trial with cabergoline (0.5 mg twice a

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Levonorgestrel-releasing intrauterine system in contraception

Backman¹

2009

Expert Review of Obstetrics & Gynecology

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Contraceptive-Related Cerebral Venous Thrombosis With Profuse Vaginal Bleed

Abstract: This case illustrates that LNG-IUS can be an innovative choice for local hormonal therapy in a patient with OCP-related cerebral venous thrombosis and simultaneous vaginal bleeding.

Cited by 3 publications

References 21 publications

Cerebral Venous Thrombosis following Oral Contraceptive Pill Use for Menorrhagia: Management Dilemma

Cerebral Venous Thrombosis following Oral Contraceptive Pill Use for Menorrhagia: Management Dilemma

Unusual association of a pituitary adenoma and a neurological emergency: case report and diagnostic steps

Levonorgestrel-releasing intrauterine system in contraception

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