Cerebral Sinus Venous Thrombosis in a Patient Using Etonogestrel/Ethinyl Estradiol Vaginal Ring

Selim, Mohammad; Rakhra, Amandeep; Kassim, Thamer; Sen, Rouhin; Jabbari, Javaneh; Valenta, Carrie

doi:10.7759/cureus.3103

Cited by 2 publications

(3 citation statements)

References 14 publications

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“…Clinicians should begin with a CT head to evaluate for subarachnoid hemorrhage, depending on the acuity and severity of symptoms. Common findings on CT that may indicate CVST include cerebral edema, hemorrhagic bleeding, sinus band sign (20-30%), or empty sinus sign (δ sign) (16-46%) [ 13 ]. However, the CT head may be radiographically unremarkable.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Venous Sinus Thrombosis in an Immunocompetent HIV Patient

Rakhra¹,

Kiefer²,

Busireddy³

et al. 2021

Cureus

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Cerebral venous sinus thrombosis (CVST) is an uncommon manifestation in patients with the human immunodeficiency virus (HIV) due to the virus's prothrombotic state. Our case involves a 41-year-old Hispanic male with a past medical history of HIV on bictegravir/emtricitabine/tenofovir/alafenamide (Biktarvy), hyperlipidemia, post-traumatic stress disorder, hypogonadism with the cessation of testosterone injections one month prior, and generalized anxiety disorder who presented with retro-orbital headache, intermittent bilateral blurry vision, and flashing lights in the lower lateral left eye for one week. Vitals signs and laboratory studies were within normal limits aside from new iron deficiency anemia. Neurological exam was unremarkable. Computed tomography (CT) of the head showed evidence of a subacute cerebral infarct with hemorrhagic transformation in the right superior parietal lobe. Magnetic resonance imaging (MRI) of the brain with contrast revealed a small thrombosed cortical vein with surrounding hemorrhage and edema in the same location, in addition to a partial thrombosis of the adjacent superior sagittal sinus, which was confirmed by magnetic resonance venogram (MRV). Although cerebral angiography was performed, no intervention was attempted for the partially occluded sagittal sinus. HIV viral load was undetectable with a robust cluster of differentiation (CD) 4 count on therapy. The patient was treated with strict blood pressure control, a statin, and a heparin drip. He remained stable and was discharged on enoxaparin injections with bridging to warfarin. In summary, appropriate lab testing, imaging, and high clinical suspicion are required for proper diagnosis and treatment of venous thromboembolism (VTE) or CVST in an HIV-positive patient.

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Section: Discussionmentioning

confidence: 99%

Cerebral Venous Sinus Thrombosis in an Immunocompetent HIV Patient

Rakhra¹,

Kiefer²,

Busireddy³

et al. 2021

Cureus

Self Cite

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“…2 There have also been case reports describing the development of life-threatening ailments including portal venous thrombosis and cerebral sinus venous thrombosis. 16,17 In a study conducted by Roumen et al, the cervical cytology of patients using NuvaRing was studied. Out of 1145 subjects, only 21 individuals with normal cervical cytology at screening experienced a shift to abnormal.…”

Section: Adverse Reactionsmentioning

confidence: 99%

“…2 There have also been case reports describing the development of life-threatening ailments including portal venous thrombosis and cerebral sinus venous thrombosis. 16 , 17 …”

Section: Eng/ee Ringmentioning

confidence: 99%

Advances in contraception: vaginal contraceptive rings

Al-Haddad

Branham

Clare

2023

Clin Med�Insights�Reprod�Health

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The vaginal contraceptive ring is very effective and user dependent. In this article, we will discuss the different types of vaginal contraceptive rings, namely, the etonogestrel/ethinyl estradiol (ENG/EE) ring (NuvaRing, Merck, Rahway, NJ, USA) and the segesterone acetate (SA)/EE (Annovera, Mayne Pharma, Raleigh, NC, USA) ring. The details of dosing and administration, indications, advantages, disadvantages, and cost-effectiveness are presented. This literature review was conducted using PubMed and Google Scholar. The search terms included ‘vaginal contraceptive ring’, ‘etonogestrel/ethinyl estradiol ring’, and ‘segesterone acetate/ethinyl estradiol ring’. The search was then sorted by year from 2000 until present, and the most recent articles were reviewed. The purpose of this article is to provide a comprehensive reference on the two vaginal contraceptive rings widely used in the United States for clinicians to guide management. Both vaginal contraceptive rings are combination of hormonal contraceptives that suppress ovulation and create physiologic conditions unfavorable for pregnancy. The ENG/EE ring is designed to be replaced monthly, while the SA/EE ring is a single device used over the course of 1 year. Common side effects of both devices include headaches, nausea, vomiting, and vaginitis. Serious adverse reactions can occur with the vaginal contraceptive rings including venous thromboembolism, psychiatric events, and hypersensitivity. Both devices are contraindicated in patients at high risk for arterial or venous thrombotic events, patients with a history of breast cancer or other estrogen/progesterone cancers, and patients with severe liver disease. Overall, the vaginal contraceptive ring is well tolerated and liked by patients. Patients should be well counseled on known severe adverse reactions. The vaginal contraceptive ring is more expensive than other forms of contraception and this should be an important point of discussion with patients.

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Cerebral Sinus Venous Thrombosis in a Patient Using Etonogestrel/Ethinyl Estradiol Vaginal Ring

Cited by 2 publications

References 14 publications

Cerebral Venous Sinus Thrombosis in an Immunocompetent HIV Patient

Cerebral Venous Sinus Thrombosis in an Immunocompetent HIV Patient

Advances in contraception: vaginal contraceptive rings

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