Cerebral venous sinus thrombosis in a 30-year-old woman on medroxyprogesterone acetate: a case report

About 80% of patients diagnosed with cerebral venous sinus thrombosis (CVST) exhibit a prothrombotic risk factor or an identifiable direct cause. The use of combined oral contraceptives (COC) is well recognized as a significant risk factor among women. Furthermore, it has been demonstrated that progestins, whether administered alone or in conjunction with ethinyl estradiol, are also linked to an increased risk of venous thrombosis. This study presents the first documented case in Ivory Coast of cerebral venous thrombosis in a young woman without any other identifiable prothrombotic risk factors, who was receiving depot medroxyprogesterone acetate (DMPA), a long-acting injectable progestin contraceptive. The patient, a 30-year-old right-handed female, was utilizing a progestin-based contraceptive method (medroxyprogesterone acetate, PROVERA DEPO) administered quarterly. At the time of her admission to the neurology department, she was receiving her second injection and presented with recent, atypical headaches that escalated rapidly. The neurological examination upon admission revealed signs of intracranial hypertension and a spastic pyramidal syndrome affecting the left side. Neuroimaging studies, including CT and MRI, identified cerebral venous thromboses in the right sinus and the superior sagittal sinus. Further investigations did not reveal any abnormalities associated with thrombophilia, autoimmune disorders, neoplasms, or infections. The patient received anticoagulant therapy at an effective dosage for a duration of six months, resulting in a reduction of headaches and the resolution of motor deficits. Any neurological event in a patient receiving Medroxyprogesterone Acetate, necessitates a neuroimaging evaluation to rule out the presence of CVST.