Dural sinus and cerebral venous thrombosis. Incidence in young women receiving oral contraceptives.

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2 cases are presented of dural sinus and cerebral venous thrombosis in obese but healthy women who were using oral contraceptives. The first was 35-year-old with 5 children and a history of eclampsia and hypertension. She had used Enovid (norethynodrel and mestranol) intermittently for 2 years. She first noted right sided headache then gradually nausea vomiting diarrhea seizures weakness urinary incontinence. On hospitalization 5 days later an echoencephalogram showed shift of midline structures to the left a brain scan showed increased uptake on the right and an angiogram suggested an avascular mass. Craniotomy revealed an intracerbral hematoma and cortical vein thrombosis. She died 1 week later. The autopsy demonstrated thrombi in the superior sagittal sinus and a right frontal hematoma suggesting that the cortical vein thrombi propagated back leading to stasis infarction and hemorrhage. The second case was a 27-year-old mother of 3 who had been taking Ortho-Novum (norethindrone and mestranol) for 12 days. She had 2 days of severe headache then loss of dexterity and visual acuity. No venous pulsation could be seen in the optic fundi. Angiogram showed lack of filling of cortical veins. Spinal fluid had an opening pressure of 400 mm 320 red cells /ml and 80 mg protein/ml. On the fifth day she had Jacksonina seizures and on the eleventh day maximal shift of midline structures 8 cm to the left was measured. Except for thrombophlebitis of right leg and pulmonary embolism she gradually improved. Anticoagulant therapy is not advisable for patients with cerebral venous thrombosis after neurologic signs have developed for fear of evoking cerebral hemmorhage.