Cerebral Venous Sinus Thrombosis Associated With a Combined Contraceptive Ring

Abstract

Combined contraceptive vaginal rings are used as an alternative to oral contraceptives with a purported advantage of allowing lower hormonal doses, and thus potentially confer a lower venous thromboembolism risk. Cerebral venous sinus thrombosis (CVST) has not been previously described in association with use of a combined contraceptive ring. A 32-year-old white woman presented with severe headache progressively worsening over days and subsequently developed acute left sided hemiplegia and sensory loss. Brain imaging revealed acute right parietal cortical infarction and extensive CVST. Evaluation for primary thrombophilia was unrevealing. The sole hypercoagulable risk factor identified was use of a vaginal contraceptive ring. The patient was anticoagulated and demonstrated marked clinical improvement. We report the first described case of CVST associated with use of a vaginal contraceptive ring. CVST should be recognized as a potentially fatal complication related to this therapy.