A 36-year-old woman on combined oral contraceptives (COC) develops sudden unilateral severe headache with contralateral arm weakness. She smokes 15 cigarettes/day. On examination she has BP 145/90 mmHg. What is the MOST appropriate action?
- A Immediately discontinue COC; investigate for cerebral venous sinus thrombosis ✓
- B Switch to progestogen-only pill and continue contraception
- C Reduce oestrogen dose to 20 mcg ethinyl oestradiol
- D Add aspirin to reduce thrombotic risk while continuing COC
Correct answer: A. Immediately discontinue COC; investigate for cerebral venous sinus thrombosis
Explanation
This presentation is highly suggestive of cerebral venous sinus thrombosis (CVST) — a rare but life-threatening complication of COC use, especially with additional risk factors (smoking, hypertension, age >35). COC must be immediately discontinued. Investigation includes brain MRI/MRV. Switching to a progestogen-only pill is not appropriate in the acute setting before diagnosis. Reducing oestrogen dose does not address the acute neurological emergency.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.