Dangerous Headache: A Case of Dural Venous Sinus Thrombosis with Protein S Deficiency

Abstract

A 23-year-old male presented to dental clinic with three months history of bifrontal pulsatile headache which was associated with nasal congestion, right facial numbness. Subsequently, he complained of photophobia and pulsatile tinnitus in both the ears for past two weeks. The pain intensity was 4 on the Visual Analogue Scale (VAS) lasting five hours and gradually progressed over the next five days to a score of 6 on VAS.There was no previous history of trauma and no family history of headache, migraines. There was no prior history of thrombosis and thrombophilic predisposition. His past medical history was remarkable for maxillary sinusitis for which he had been on self medication acetaminophen 650 mg (Dolo 650) three times a day as required for past one month. On physical examination he was conscious, oriented, and haemodynamically stable with normal visual acuity but grade III papilloedema on fundus examination. Rests of the cranial examinations were normal and there was no motor or sensory deficit or incoordination. Signs of meningeal irritation were present with positive kernig's sign.Preliminary laboratory investigations including a complete haemogram, routine urine test were normal. The Cerebrospinal