Not Just Another Headache: Cerebral Venous Sinus Thrombosis in a Patient With Isolated Antithrombin III Deficiency

Abstract

Cerebral venous sinus thrombosis (CVST) is a rare condition. Symptoms and signs arise from a combination of thrombosis of cerebral veins and increased intracranial pressure. The most common presenting symptom is a non-descriptive headache, but presentation varies with underlying etiology. CVST requires a high index of suspicion to diagnose, particularly in those without apparent risk factors. Evaluation and diagnosis should include a combination of a thorough history, ophthalmoscopic examination, laboratory studies, and imaging. Management is multidimensional and aims to reverse the underlying causes, and prompt treatment with anticoagulation by heparin to decrease thrombotic burden, risk of permanent neurological deficits, and death. In the present study, we report the case of a 61-year-old man referred to the emergency department by an ophthalmologist for bilateral papilledema and eventually diagnosed with CVST secondary to isolated antithrombin III deficiency. Although CVST is uncommon, this case is worthwhile to report as the presentation is unique, and it requires a high index of clinical awareness for timely diagnosis and early therapeutic intervention.

Comparison of clinical and laboratory parameters in patients with migraine or tension-type headaches: A case-control study

“…In our study, there was a significant difference between the groups in terms of antithrombin III level, which was higher in the TTH group compared to the other groups. Since some studies reported that headaches may occur due to thrombosis secondary to antithrombin III deficiency [18,19], future studies may benefit from assessing this particular parameter in migraine patients with migraine or TTH.…”

Management of Antithrombin Deficiency in Pregnancy

“…6 Patients with AT deficiency mainly present with deep vein thrombosis (DVT) and pulmonary embolism (PE), whereas the cerebral sinus and abdominal veins are rarely affected. 7 8 9 10 11 Arterial thrombosis is not characteristic of AT deficiency, but cases of it have been reported. 12 13…”

“…6 Patients with AT deficiency mainly present with deep vein thrombosis (DVT) and pulmonary embolism (PE), whereas the cerebral sinus and abdominal veins are rarely affected. [7][8][9][10][11] Arterial thrombosis is not characteristic of AT deficiency, but cases of it have been reported. 12,13 AT deficiency is transmitted as an autosomal disorder, and the penetrance is very high, with more than 50% of individuals experiencing a thromboembolic event before the age of 50 years.…”