Cerebral vein and sinus thrombosis and hyperthyrodism: A case report and a systematic review of the literature

Abstract

Cerebral vein and sinus thrombosis (CVST) is an uncommon disease with an estimated incidence of 4 per 1,000,000 per year and with a mortality rate ranges from 5% to 30% [ [1] Stam J. Cerebral venous and sinus thrombosis: incidence and causes. Adv Neurol. 2003; 92: 225-232 PubMed Google Scholar ]. CVST has been associated with several causes and risk factors, such as oral contraceptives, pregnancy, puerperium, infections, and inherited thrombophilia. However, ~25% of cases of CVST are still considered to be unprovoked [ [1] Stam J. Cerebral venous and sinus thrombosis: incidence and causes. Adv Neurol. 2003; 92: 225-232 PubMed Google Scholar ]. A hypercoagulable state has been extensively described in hyperthyroidism and, recently, increasing levels of free thyroxine have been claimed as a risk factor for a first venous thrombosis in the leg [ 2 Squizzato A. Romualdi E. Büller H.R. Gerdes V.E. Clinical review: Thyroid dysfunction and effects on coagulation and fibrinolysis: a systematic review. J Clin Endocrinol Metab. 2007; 92: 2415-2420 Crossref PubMed Scopus (171) Google Scholar , 3 van Zaane B. Squizzato A. Huijgen R. van Zanten A.P. Fliers E. Cannegieter S.C. Increasing levels of free thyroxine as a risk factor for a first venous thrombosis: a case-control study. Blood. 2010; 115: 4344-4349 Crossref PubMed Scopus (52) Google Scholar ]. Indeed, cases of CVST during thyrotoxicosis were described since the beginning of the previous century [ 4 Doyle J.B. Obstruction of the longitudinal sinus. Arch Neurol Psychiatry. 1927; 29: 374-382 Crossref Scopus (13) Google Scholar , 5 Squizzato A. Gerdes V.E. Brandjes D.P. Büller H.R. Stam J. Thyroid diseases and cerebrovascular disease. Stroke. 2005; 36: 2302-2310 Crossref PubMed Scopus (176) Google Scholar , 6 Verberne H.J. Fliers E. Prummel M.F. Stam J. Brandjes D.P. Wiersinga W.M. Thyrotoxicosis as a predisposing factor for cerebral venous thrombosis. Thyroid. 2000; 10: 607-610 Crossref PubMed Scopus (46) Google Scholar ]. In addition to hypercoagulability, hemodynamic factors, dehydration, and stasis of venous blood flow attributable to goiter may also contribute to the multifactorial pathogenesis of CVST. Aim of this paper is to describe a case of a patient with Graves’ disease that developed an apparently unprovoked CVST, and to review the existing literature on the association between CVST and thyrotoxicosis.