Cerebral venous sinus thrombosis due to oral contraceptive use: Postmortem 3T-MRI and autopsy findings

Cerebral vein thrombosis in a woman using oral contraceptive pills for a short period of time: a case report

BACKGROUND

Cerebral vein thrombosis is increasing in young adults. Although oral contraceptive pills increase the risk of cerebral vein thrombosis, relatively high brain venous involvement is rare when oral contraceptive pills are consumed for a short duration.

CASE PRESENTATION

A 31-year-old Asian woman was referred to Imam Reza Hospital with a headache complaint on 11 November 2020. The woman, who had a headache for the previous 11 days, went to the hospital. Owing to endometriosis involvement, she consumed Diane tablets. According to the imaging findings, three vein involvements were diagnosed. Anticoagulant therapy was started, and the symptoms disappeared.

CONCLUSIONS

All cerebral vein thrombosis symptoms are variable, but new presentation of headache could be an early symptom of cerebral vein thrombosis.

A Novel Mouse Model for Cerebral Venous Sinus Thrombosis

Cerebral venous sinus thrombosis (CVST) is an uncommon cause of stroke resulting in parenchymal injuries associated with heterogeneous clinical symptoms and prognosis. Therefore, an experimental animal model is required to further study underlying mechanisms involved in CVST. This study is aimed at developing a novel murine model suitable and relevant for evaluating injury patterns during CVST and studying its clinical aspects. CVST was achieved in C57BL/6J mice by autologous clot injection into the superior sagittal sinus (SSS) combined with bilateral ligation of external jugular veins. Clot was prepared ex vivo using thrombin before injection. On days 1 and 7 after CVST, SSS occlusion and associated-parenchymal lesions were monitored using different modalities: in vivo real-time intravital microscopy, magnetic resonance imaging (MRI), and immuno-histology. In addition, mice were subjected to a neurological sensory-motor evaluation. Thrombin-induced clot provided fibrin- and erythrocyte-rich thrombi that lead to reproducible SSS occlusion at day 1 after CVST induction. On day 7 post-CVST, venous occlusion monitoring (MRI, intravital microscopy) showed that initial injected-thrombus size did not significantly change demonstrating no early spontaneous recanalization. Microscopic histological analysis revealed that SSS occlusion resulted in brain edema, extensive fibrin-rich venular thrombotic occlusion, and ischemic and hemorrhagic lesions. Mice with CVST showed a significant lower neurological score on post-operative days 1 and 7, compared to the sham-operated group. We established a novel clinically CVST-relevant model with a persistent and reproducible SSS occlusion responsible for symptomatic ischemic and hemorrhagic lesions. This method provides a reliable model to study CVST physiopathology and evaluation of therapeutic new regimens.