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Cerebral venous thrombosis — RCPSC EM MCQ

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HardNeurological emergenciesCerebral venous thrombosisRCPSC EM

A 30-year-old postpartum woman has progressive headache, vomiting and a focal seizure eight days after delivery. Blood pressure is 138/86 mmHg. CT head is normal; D-dimer is elevated and neurological examination shows mild left arm drift. What is the most appropriate initial management?

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Correct answer: E — Order CT venography or MR venography and start anticoagulation if cerebral venous thrombosis is confirmed

Postpartum state, severe headache, seizure and focal deficit suggest cerebral venous thrombosis. Venous imaging is required because non-contrast CT can be normal.

Reference: Canadian Stroke Best Practices; Rosen's Emergency Medicine