A 15 yo M presents to the ED with headache x 3 days.  He reports associated nausea, vomiting x 3. He denies past medical history and has never had a similar headache. His sister does have a history of protein S deficiency. On exam, he is uncomfortable appearing and does have photophobia. He has no neurologic deficits. A CT head without contrast is normal. A CT venogram is performed and shown below.  What's the diagnosis?   (scroll down for answer)

Answer: Left transverse sinus thrombosis

Central Venous Thrombosis

• Presents with diffuse headache that may be sudden in onset or progressive
• Impaired venous drainage --> increased ICP
• Venous occlusion --> ischemia, infarction, hemorrhage --> focal neurologic deficits or seizure
• Associated with hypercoagulable states
• Recent surgery, estrogen use, factor V Leiden, pregnancy/postpartum, and hypercoagulability diseases such as protein S deficiency
• Diagnosis
• Elevated opening pressure on LP
• CTV or MRV (definitive)
• Treatment
• Anticoagulation
• Thrombolysis or thrombectomy may be considered

References:

Harrigan M, Felix AG. Headache. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds.Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eNew York, NY: McGraw-Hill; 2016.

Kwiatkowski T, Friedman BW. Headache Disorders. Rosen’s Emergency Medicine: Concepts and Clinical Practice, 9e. Elsevier: 2018.