Neurotologic presentation of sagittal sinus thromboses associated with oral contraceptive usage

Thrombosis of the cerebral venous sinuses has long been a recognized complication of late stage pregnancy and the puerperium; more recently, this complication has been associated with the use of oral contraceptives. Two cases are presented in which the presenting symptoms of sagittal sinus thrombosis were neurotologic in nature. One case presented with a sudden onset unilateral facial paralysis; another case presented with pressure/fullness sensation in one ear accompanied by nausea and vomiting. Clinical presentation and evaluation of these cases is presented, with a discussion of symptom etiology. Recommended non-invasive medical management methods are discussed. Cases in which the thrombosis involves the sigmoid, transverse, and sagittal sinuses should be suspect for etiologic sources beyond the ear even when the presenting symptoms are neurotologic in nature. Management of these cases is different from that of an otogenic sigmoid sinus thrombosis. A complete medical history taken from women of child bearing age should include the use of oral contraceptives, which may be suspect for inducing intracranial venous thromboses.