Severe headache as a monosymptom of cerebral venous sinus thrombosis: a case report with effective utilization of the SNNOOP10 approach
Garik Yeganyan1,*, Hasmik Sargsyan2, Mariam Manukyan2, Henrik Schytz3, Samson Khachatryan 4,5
1 Department of Neurology, Vanadzor Medical Center, Vanadzor, Armenia
2 Department of Neurology, Erebouni Medical Center, Yerevan, Armenia
3 Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
4 Department of Neurology and Neurosurgery, Avdalbekyan National Institute of Health, Yerevan, Armenia
5 Somnus Neurology Clinic, Yerevan, Armenia
ABSTRACT
Introduction: Headache is one of the most common complaints worldwide with a lifelong prevalence of 96% in the general population. The worldwide prevalence of secondary headaches is estimated to be 18%. Running an extensive work-up, including imaging and blood tests are not recommended in every headache patient, since the risk of false-positive results and incidental findings is high. The SNNOOP10 list was proposed to identify red flags for secondary headaches. “Pattern change or recent onset of new headache” is one of the red flags in SNNOOP10.
Case Report: The patient in this case report presented to the outpatient department with a history of 3-day-long very severe headache. She had never experienced a similar headache and did not have any chronic diseases. Neuroimaging showed evidence of cerebral venous sinus thrombosis. Hyperthyroidism was also detected and was assumed to be an associated factor for the cerebral venous thrombosis due to a possible increase in procoagulant and antifibrinolytic activity. Antithrombotic, anticonvulsant, antithyroid, symptomatic and supportive therapy were initiated. The patient was discharged on day 14 with mild headaches and no neurological deficit. At three-month follow-up, the patient had no complaints with no pathologies on the computed tomography scan.
Conclusion: This case showed the effectiveness of SNNOOP10 approach in emergency situations in a patient with a new onset headache.
Keywords: secondary headache, red flag, hypercoagulable state, hyperthyroidism, SNNOOP10