Case 2
A 17-year-old Caucasian female (BMI 32.5 kg/m2) presented with worsening headaches associated with vomiting for 2 weeks. Head magnetic resonance venography (MRV) revealed right dural, transverse and sigmoid sinus venous thrombosis (Figure 2 and 2b). Patient reported the use of COC for 2 years (norethindrone 1mg -ethinyl estradiol 35 mcg) prescribed for the management of menorrhagia. Anticoagulation with Apixaban was continued for a total duration of 6 months with repeat MRV showing residual non-occlusive residual thrombosis in the right transverse and sigmoid sinuses. Thrombophilia evaluation did not reveal congenital or acquired abnormalities.