Cerebral Venous Sinus Thrombosis Following Oral Contraceptive Use: A Review of Published Cases

Abstract

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially devastating stroke subtype affecting
young women, and oral contraceptive (OCP) use is its most frequent reversible risk factor. Objective: To review published case reports/series of OCP-associated CVST alongside the epidemiologic, pathophysiologic, diagnostic, and management literature.
Methods: Narrative review of case reports, case-control and cohort studies, meta-analyses, and guidelines. Findings: CVST incidence is roughly 1.3 per 100,000 person-years, higher in reproductive-age women; OCP use confers a pooled odds ratio near 7-10, rising with inherited thrombophilia (prothrombin G20210A, Factor V Leiden). Published cases span isolated headache to fulminant, fatal disease, occasionally complicated by subdural hematoma or dural arteriovenous fistula. MRV/CTV is diagnostic; D-dimer has limited negative predictive value. Anticoagulation is first-line, with thrombectomy and decompressive craniectomy for refractory or malignant courses.
Conclusions: Prognosis is generally favorable with prompt anticoagulation and OCP discontinuation; guidelines support
progestin-only or non-hormonal contraception thereafter.