Unmasking hidden risks: cerebral venous sinus thrombosis and spontaneous subdural hematoma in women on oral contraceptives - insights from a case report and systematic literature review.

Background And Objective: Cerebral venous thrombosis (CVT) is a rare but critical condition, particularly in young women, often linked to oral contraceptive use. It can lead to complications like subdural hematoma (SH), which are challenging to diagnose and manage. We report the case of a 39-year-old woman who presented with severe headaches and neurological symptoms, leading to a diagnosis of chronic SH and CVT, associated with long-term oral contraceptive use. This case is unique as it documents the first known instance of chronic SH associated with CVT induced by oral contraceptives. Our objective was to explore this association using the Bradford Hill criteria and to review the diagnostic and therapeutic challenges of CVT and SH in this population.

Methods: We conducted a systematic literature review adhering to PRISMA guidelines, focusing on SH cases linked to CVT in women using oral contraceptives.

Results: Including our case, four cases of SH associated with CVT secondary to oral contraceptive use were identified. Common symptoms included severe headache and neurological deficits. All patients received anticoagulation therapy, with surgical intervention required in severe cases. Prognosis was generally favorable with appropriate management.

Conclusion: This case emphasizes the importance of considering CVT in women presenting with spontaneous SH, particularly those on oral contraceptives. Early diagnosis, careful clinical and radiological monitoring, and timely surgical intervention are crucial for optimal outcomes.