European Journal of Biomedical and Pharmaceutical Sciences

A CASE REPORT ON NORETHISTERONE INDUCED CEREBRAL VENOUS THROMBOSIS WITH VENOUS INFRACT IN LEFT PARIETAL LOBE

Vaishnav S. R.*, Anupama P. S., Dr. Chitra C. Nair and Dr. Beena P.

ABSTRACT

Cerebral venous thrombosis (CVT) is a rare but potentially life-threatening condition with varied neurological
presentations. Drug-induced CVT is uncommon, though oral contraceptives are recognized risk factors.
Norethisterone, a synthetic progestogen, has been implicated in CVT development, though its role is not fully
understood. A 46-year-old female presented with a 4-day history of headache, vomiting, and right-sided weakness
and numbness. She had been on Norethisterone 5 mg daily and Tranexamic acid for abnormal uterine bleeding
over the past month. MRI and CT imaging revealed dural venous sinus and cortical vein thrombosis with
associated hemorrhagic infarcts. Laboratory investigations showed anemia, low MCV and MCH, and elevated
WBC with neutrophilia. Thrombophilia screening was negative, ruling out inherited or acquired hypercoagulable
states. A diagnosis of drug-induced CVT secondary to Norethisterone use was made, supported by imaging
findings of thrombosis in the superior sagittal sinus, transverse and sigmoid sinuses, and cortical veins. The patient
received anticoagulation (Enoxaparin and Rivaroxaban), antiedema measures, antiepileptics, steroids, diuretics,
and antibiotics. She developed papilledema during hospitalization, which was managed successfully. Follow-up
imaging showed stable findings. The patient improved clinically and was discharged after 15 days with no
significant neurological deficits. This case emphasizes the need to consider drug-induced CVT in patients with
neurological symptoms who are receiving progestogen therapy. Early diagnosis and prompt anticoagulation are
critical for favorable outcomes.

Keywords: Cerebral venous thrombosis, Norethisterone, Venous hemorrhagic infarct, MRI.