A 29 year-old african lady presented to the casualty for first seizure in life time.
She complained of headache and mild slurring of speech one day prior to the seizure. She denied any use of oral contraceptive, and there was no history of alcohol or drug abuse. Neither was there any significant family history. On physical examination, her GCS was 15/15, and no neck stiffness could be detected. There was no focal neurological deficit. First CT brain (plain) showed no abnormality. During light stimulation at EEG session, she developed generalized tonic-clonic convulsion lasting for 45 seconds. An urgent contrast CT brain was performed in view of the normal first CT.
What abnormality is shown? What will be your investigation?
Click read more for answer
Answer: Transverse sinus thrombosis
The contrast CT showed presence of filling defect over left transverse sinus with asscoiated infarct over left temporo-occipital lobe compatible with venous infarct. The patient was strated on low molecular weight heparin and then anticoagulation, and nil seizure relapse after anticonvulsant.
At the time of this quiz, underlying aetiology is still unknown. Sickle cell anemia is one of the differential, but is not present in this case. Patient never takes OC pill which is one important risk factor. Immune marker and lupus anticoagulant had been negative. Assay for protein S and protein C are still pending.