A Progressive Headache

Cerebral venous thrombosis is an uncommon but important cause of stroke. A 34-year-old female who had recently started taking the oral contraceptive pill presented with a severe headache with progressively worsening symptoms of nausea, vomiting and photophobia suggestive of raised intracranial pressure. CVT typically presents with symptoms related to raised intracranial pressure that often worsen over time and can progress to include focal symptoms secondary to venous ischaemia or haemorrhage such as hemiparesis or seizures. There is a often a delay to diagnosis and initiating treatment due to the often insiduous nature of symptoms and rareness of the condition. Plain CT is normal in the majority of cases and CVT should be considered in anyone with a worsening severe headache with features suggestive of raised intracranial pressure such as nausea and vomiting or photophobia and without a prior history of migraine. The case discusses correct imaging for diagnosis and management of this potentially life threatening stroke more often found in younger patients.