What is the cause, diagnosis, and management of a 28-year-old female with cerebral venous sinus thrombosis (CVST) of the transverse sinus, presenting with severe anemia (ana 4+), protein S deficiency, papilledema, and mild mastoiditis?

Differential Diagnosis for Cerebral Venous Sinus Thrombosis

Single Most Likely Diagnosis

• Protein S deficiency: Given the patient's laboratory results showing a protein S deficiency, this is a strong predisposing factor for cerebral venous sinus thrombosis (CVST). Protein S is an anticoagulant protein, and its deficiency increases the risk of thrombosis.

Other Likely Diagnoses

• Oral contraceptive use or other estrogen-related conditions: Although not explicitly mentioned, the patient's age and gender suggest the possibility of oral contraceptive use, which is a known risk factor for CVST.
• Inflammatory conditions: The presence of mild mastoiditis could indicate an underlying inflammatory process that might contribute to the development of CVST.
• Hypercoagulable state due to other causes: Other conditions such as factor V Leiden mutation, antithrombin deficiency, or antiphospholipid syndrome could also be contributing factors, although they are not specified in the provided information.

Do Not Miss Diagnoses

• Meningitis or brain abscess: These conditions could present with similar symptoms such as headache, papilledema, and could be complicated by or mimic CVST. Missing these diagnoses could be fatal.
• Intracranial hypertension due to other causes: Conditions like idiopathic intracranial hypertension (IIH) could present with papilledema and should be considered to avoid missing a potentially treatable cause of increased intracranial pressure.

Rare Diagnoses

• Behçet's disease: A rare condition that can cause CVST, especially in the absence of other clear risk factors. It is characterized by a combination of recurrent oral ulcers, genital ulcers, and ocular inflammation.
• Neurosarcoidosis: Although rare, sarcoidosis can cause CVST and should be considered if other systemic symptoms are present, such as lung involvement or skin lesions.
• Pseudotumor cerebri (Idiopathic Intracranial Hypertension) with secondary CVST: While not the primary diagnosis, IIH can rarely be associated with CVST, making it a consideration in the differential diagnosis.