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Indian Journal of Emergency Medicine

Volume  10, Issue 1, January-March 2024, Pages 7-10
 

Case Report

An Unusual Case of Headache: Joining the Dots in the Emergency Room

Rimy Dey

1 Trainee, Department of Emergency Medicine, Paras Hospitals, Gurgaon 122002, Haryana, India.

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.10124.1

Abstract

Headache is one of the commonest presenting complaints in the Emergency Room. In the young population with no significant history of any medical condition or trauma, it seldom raises suspicion of an ominous etiology. In this case report we present an unusual case of a young unmarried female presenting to the ED with acute onset headache and vomiting. After initiation of primary treatment, the patient was subjected to MRA and MRV of the brain which was suggestive of thrombosed mid part of Superior Sagittal Sinus, right Sigmoid and right Transverse sinus. On eliciting the SAMPLE history of the patient, the risk factor of polycystic ovarian syndrome and intake of Norethisterone for Abnormal Uterine Bleeding was known. Provisional diagnosis of Norethisterone induced Cerebral Venous Sinus Thrombosis was considered and patient was initiated on treatment with Enoxaparin (Low Molecular weight Heparin) followed by long term NOAC and lifetime avoidance of Norethisterone and other prothrombotic drugs.


Keywords : Headache; Cerebral Venous Sinus Thrombosis; Norethisterone acetate; Enoxaparin; Rivaroxaban.
Corresponding Author : Rimy Dey