Cerebral venous thrombosis, pregnancy and oral contraceptives

Cerebral venous thrombosis (CVT) is a rare variety of cerebro-vascular disease accounting for 0.5% of all stroke. It can occur at any age. It has a 3/1 female preponderance with a peak in young women due to gender specific risk factors, especially oral contraceptives and to lesser extent pregnancy, post-partum, and in vitro fertilization. Despite a wide variety of clinical presentations, early diagnosis, mostly based on MRI/MRA, is crucial but often difficult particularly during post-partum because of the numerous causes of headache that may occur after delivery. Antitrombotic treatment based on low molecular weight heparin and symptomatic treatment should be started as rapidly as possible. The overall prognosis of CVT is much better than that of arterial stroke and it is even better in women with gender specific risk factors, with a complete recovery in 80% of patients. Future pregnancy is not contra-indicated, but contraception with oestro-progestogens is definitely contra-indicated.