-Case Reports-

Deep Cerebral Vein Thrombosis Triggered by Contraceptive Use in a Woman with Non-Overt Essential Thrombocythemia

Po-Jen Hsu¹, Chih-Hao Chen² and Shinn-Kuang Lin^1,3

¹Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
²Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
³School of Medicine, Tzu Chi University, Hualien, Taiwan

Cerebral venous thrombosis is common in individuals using contraceptives. However, the potential existence of an underlying occult prothrombotic condition is frequently overlooked. We report a case of a 46-year-old woman who experienced acute cerebral venous thrombosis, primarily affecting the deep cerebral veins, after a month of contraceptive use. The distinctive "unicorn" pattern observed in the attenuated vein signs on the sagittal plane of non-contrast brain computed tomography served as crucial indicators for diagnosing deep cerebral vein thrombosis. The patient's platelet counts slightly increased during initial admission. However, a gradual increase in the platelet count coupled with the presence of the JAK2 V617F mutation over the subsequent 2 years led to the diagnosis of essential thrombocythemia. After the initiation of cytoreductive treatment, the platelet counts rapidly decreased to the normal range. Myeloproliferative neoplasms (MPNs) should be considered in individuals with cerebral venous thrombosis. The JAK2 V617F mutation is a valuable target for MPNs screening. Clinicians can choose a more appropriate course of treatment and lower the risk of recurrent thrombosis if they promptly detect other prothrombotic states in the patient.

J Nippon Med Sch 2025; 92: 450-456

Keywords
cerebral venous thrombosis, contraceptive, essential thrombocythemia, myeloproliferative neoplasms, unicorn sign

Correspondence to
Shinn-Kuang Lin, MD, Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan
stuartlin0428@gmail.com, sk2022@tzuchi.com.tw

Received, July 19, 2024
Accepted, August 28, 2024