Abstract
We report a case of cerebral venous thrombosis (CVT) in a 38-year-old Japanese woman who had been suffering from migraine without aura. Twenty-two days before admission to our hospital, she had begun taking a LEP (low-dose estrogen progestin) oral contraceptive (OC) formulation for treatment of dysmenorrhea. Ten days after the start of OC administration, she developed a progressively worsening headache. Before admission to our hospital, she was misdiagnosed as having migrainous headache and treated with triptan. On admission, she showed pure alexia and papilledema. Computed tomography (CT) showed a cerebral hemorrhagic infarct in the left occipitotemporal lobe, and magnetic resonance venography (MRV) revealed occlusion of the left transverse sinus. Due to her hypermenorrheal bleeding, laboratory data revealed severe iron deficiency anemia concomitant with D-dimer elevation. She was then diagnosed as having CVT, and treated with heparin and blood transfusion. She recovered well, except for residual mild pure alexia.
OCs containing estrogen and progestin are medications taken by mouth for birth control. The risk of CVT from OC use is well known. The LEP formulation is also an estrogen progestin compound tablet whose use is indicated for dysmenorrhea. It is necessary to be aware that the risk associated with LEP use is higher in patients with severe anemia than in those without.
