Unmasking hidden risks: cerebral venous sinus thrombosis and spontaneous subdural hematoma in women on oral contraceptives – insights from a case report and systematic literature review

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie Pub Date : 2024-10-10 DOI:10.1016/j.neuchi.2024.101603

Marta Arrighi , Quentin Berton , Emmanuel de Schlichting , Djene Ibrahima Kaba , Paul Roblot , Guillaume Coll

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Abstract

Background and objective

Cerebral venous thrombosis (CVT) is a rare but critical condition, particularly in young women, often linked to oral contraceptive use. It can lead to complications like subdural hematoma (SH), which are challenging to diagnose and manage. We report the case of a 39-year-old woman who presented with severe headaches and neurological symptoms, leading to a diagnosis of chronic SH and CVT, associated with long-term oral contraceptive use. This case is unique as it documents the first known instance of chronic SH associated with CVT induced by oral contraceptives. Our objective was to explore this association using the Bradford Hill criteria and to review the diagnostic and therapeutic challenges of CVT and SH in this population.

Methods

We conducted a systematic literature review adhering to PRISMA guidelines, focusing on SH cases linked to CVT in women using oral contraceptives.

Results

Including our case, four cases of SH associated with CVT secondary to oral contraceptive use were identified. Common symptoms included severe headache and neurological deficits. All patients received anticoagulation therapy, with surgical intervention required in severe cases. Prognosis was generally favorable with appropriate management.

Conclusion

This case emphasizes the importance of considering CVT in women presenting with spontaneous SH, particularly those on oral contraceptives. Early diagnosis, careful clinical and radiological monitoring, and timely surgical intervention are crucial for optimal outcomes.

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揭开隐藏的风险：口服避孕药妇女的脑静脉窦血栓和自发性硬膜下血肿--从病例报告和系统性文献回顾中获得的启示。

背景和目的：脑静脉血栓（CVT）是一种罕见但严重的疾病，尤其是在年轻女性中，通常与口服避孕药有关。它可导致硬膜下血肿（SH）等并发症，诊断和处理都具有挑战性。我们报告了一例 39 岁女性的病例，她出现了严重的头痛和神经症状，最终被诊断为慢性 SH 和 CVT，这与长期口服避孕药有关。这个病例是独一无二的，因为它记录了首个由口服避孕药诱发慢性 SH 和 CVT 的已知病例。我们的目的是利用布拉德福德-希尔（Bradford Hill）标准探讨这种关联，并回顾该人群中 CVT 和 SH 的诊断和治疗难题：我们按照 PRISMA 指南进行了系统性文献综述，重点关注使用口服避孕药的女性中与 CVT 相关的 SH 病例：结果：包括我们的病例在内，共发现了四例因口服避孕药而继发 CVT 的 SH 相关病例。常见症状包括剧烈头痛和神经功能障碍。所有患者都接受了抗凝治疗，严重病例需要手术治疗。通过适当的治疗，预后普遍良好：本病例强调了对自发性 SH 女性，尤其是口服避孕药的女性考虑 CVT 的重要性。早期诊断、仔细的临床和放射学监测以及及时的手术干预是获得最佳预后的关键。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurochirurgie 医学-临床神经学

CiteScore

2.70

自引率

6.20%

发文量

100

审稿时长

29 days

期刊介绍： Neurochirurgie publishes articles on treatment, teaching and research, neurosurgery training and the professional aspects of our discipline, and also the history and progress of neurosurgery. It focuses on pathologies of the head, spine and central and peripheral nervous systems and their vascularization. All aspects of the specialty are dealt with: trauma, tumor, degenerative disease, infection, vascular pathology, and radiosurgery, and pediatrics. Transversal studies are also welcome: neuroanatomy, neurophysiology, neurology, neuropediatrics, psychiatry, neuropsychology, physical medicine and neurologic rehabilitation, neuro-anesthesia, neurologic intensive care, neuroradiology, functional exploration, neuropathology, neuro-ophthalmology, otoneurology, maxillofacial surgery, neuro-endocrinology and spine surgery. Technical and methodological aspects are also taken onboard: diagnostic and therapeutic techniques, methods for assessing results, epidemiology, surgical, interventional and radiological techniques, simulations and pathophysiological hypotheses, and educational tools. The editorial board may refuse submissions that fail to meet the journal''s aims and scope; such studies will not be peer-reviewed, and the editor in chief will promptly inform the corresponding author, so as not to delay submission to a more suitable journal. With a view to attracting an international audience of both readers and writers, Neurochirurgie especially welcomes articles in English, and gives priority to original studies. Other kinds of article - reviews, case reports, technical notes and meta-analyses - are equally published. Every year, a special edition is dedicated to the topic selected by the French Society of Neurosurgery for its annual report.