Abstract

Background: Cerebral venous thrombosis (CVT) is an uncommon but important cause of stroke, more frequently seen in young females. Several risk factors have been identified, including pregnancy, the puerperium, anemia, polycystic ovarian syndrome (PCOS), and the use of oral contraceptive pills (OCPs). Case Presentation: We report the case of a 23-year-old woman who presented to the emergency department with a sudden-onset, severe thunderclap headache. She had been on combined oral contraceptive pills (ethinyl estradiol 0.03 mg + desogestrel 0.15 mg, Miliana) for the past three months for menstrual cycle regulation. Neuroimaging revealed cerebral venous thrombosis complicated by subarachnoid hemorrhage (SAH) a rare and diagnostically challenging presentation.Management and Outcome: The patient was managed with anticoagulation under close neurological monitoring, with careful discontinuation of OCPs. Despite the initial severity, she made a complete neurological recovery.Conclusion: This case highlights the need for heightened clinical suspicion of CVT in young women presenting with severe headache, especially those on hormonal contraceptives. Early diagnosis and appropriate anticoagulation, even in the presence of SAH, can result in favourable outcomes. A multidisciplinary approach is essential in managing the complexities of such cases

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