Male, 31 years and generally stable, a highly chronic smoker with a ?48 pack-year habit, came to emergency room with 2-week history of gradually worsening, severe, throbbing headache in the occipital region sensitive to light. Initial neurological examination was positive only for some involuntary motor tics of the left leg. Initial laboratory readings showed hemoglobin 20 g/dl and hematocrit 56.5%. The carboxyhemoglobin level was normal.
Further evaluation by MRI and MRA of the brain suggested extensive and complete thrombosis of the superior sagittal sinus, right transverse sinus and right sigmoid sinus with a small venous infarct in the right parafrontal region. Generally cerebral thrombosis due to smoking is very rare but is this a case? What to do now?