36-year-old 12-week-pregnant female, gravida 2, para 1, who is now admitted to the emergency department for severe onset of headache located bioccipital, right greater than left, vertex and frontal,
associated with severe nausea and vomiting, worse at night time. The headache began 2 weeks ago for 2 days, spontaneously remitted and returned severely last night. She has no associated visual loss, double vision, weakness, numbness or tingling. No seizures. No unsteadiness of gait. No neck pain. She does have a chronic problem in the morning of neck pain for which she ordinarily cracks
her neck. This has not worsened recently. She has had no trauma. No ear infection. No sinus infections. She has no history of spontaneous miscarriages, DVT or pulmonary emboli. She had no difficulty conceiving this child. Family history: The mother had diabetes, but there is no known
hypercoagulable disorder. The patient had gestational diabetes with her first pregnancy but is not known to have it at the present time. There is no known history of oral contraception use.
PHYSICAL EXAMINATION: General: She is awake and alert. Mental status:
Intact, although she became tearful once the diagnosis was revealed to her.
HEENT: She has no papilledema. Vital signs: Her blood pressure is in the
normal range at 112/49. Neurologic: Her extraocular movements are intact
without evidence of sixth nerve palsy. She has no drift. Her visual fields are
completely full. No sensory disturbance. Reflexes are symmetric. Toes are
downgoing.
CT head showed:
What does this CT show?
What are the next steps?
Update
on 2011-07-12 17:46 by Christian DenOuden
Plain CT: showed the Dense Triangle Sign consistent w CVT
MRV: IMPRESSION: MRV findings are consistent with dural venous sinus thrombosis of
the right sigmoid sinus, right transverse sinus, straight sinus, and major
cerebral veins.
Which on the MRV above you can see the filling defects of the venous drainage pretty easily because they are so large.
Pt was started on Lovenox to be continued throughout the pregnancy and in all future pregnancies.
Blood tests showed that she also has a protein S deficiency.
She was discharged 4 days later with no headache. No return ER visits since