Abstract
Cerebral venous thrombosis (CVT) is mostly caused by pro-thrombotic factors. Hyperthyroidism is not a wellknown risk factor. We present a case report on a 17 year old girl who developed life-threatening CVT after Graves’ disease. A review of the literature reveals further 34 cases of CVT and hyperthyroidism. Abnormalities in the coagulation system leading to hypercoagulability such as increased coagulation factors are detected in patients with hyperthyroidism, and these abnormalities seem to be thyroxin-dependent. The cause of CVT may be multi-factorial. Our patient used oral hormonal contraception without complications until the development of severe Graves’ disease. Hyperthyroidism is suspected as the main precipitating cause of CVT in this case. We recommend performing MRI with venous angiography when a hyperthyroid patient presents with unusual headache alone or in combination with other neurological symptoms. If CVT is proven, blood screening for coagulation abnormalities should be performed. On the other hand, diagnostics for finding the cause of CVT should include blood tests of thyroid function. Early treatment of CVT and hyperthyroidism is mandatory.
Highlights
Cerebral venous thrombosis (CVT) represents only about 0.5-1 % of all strokes [1]
A prospective multi-center study showed that 75% of patients with CVT were women with a mean age of 34 years and the best prognosis was found for women with risk factors like hormonal contraception, pregnancy and maternity [4]
With life-threatening CVT and thyroid crisis, was treated with plasmapheresis which led to rapid reduction of fT3 and fT4 and removal of anti-phospholipid antibodies, with significant clinical improvement and normalization of factor VIII and von Willebrand factor (vWF) [29]
Summary
Cerebral venous thrombosis (CVT) represents only about 0.5-1 % of all strokes [1]. The incidence is estimated to be 2-4 per million per year, but the number is probably higher due to undiagnosed cases [1,2]. After start of treatment with carbimazole she was discharged from the hospital, but on the same day she developed right occipital headache, pain in the neck and nausea Four days later, she had a transient hemiparesis and focal seizures in her left hand. On the fifth day she was admitted to our department after recurrent and persisting left hemiparesis and lost consciousness due to generalized seizures Her pupils were dilated, not reacting to light and Glasgow Coma Scale score at admittance was 3 points. She was treated with dalteparin, adjusted after anti-factor-X a measurements in plasma, four hours after the last injection with the level-aim between 0.6-1.0 IU/ml (reference 0.00-0.01). Graves’ disease was present among 21 of the 35 patients and 17 of these were women
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