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Case Reports
. 2013 Jul;8(3):162.
doi: 10.4103/1793-5482.121690.

Grave's disease with transverse and sigmoid sinus thrombosis needing surgical intervention

Banumathy Srikant  1 , Srikant Balasubramaniam  2
Affiliations
Case Reports

Grave's disease with transverse and sigmoid sinus thrombosis needing surgical intervention

Banumathy Srikant et al. Asian J Neurosurg. 2013 Jul.

Abstract

Thrombosis of venous sinuses associated with thyrotoxicosis is rare, and isolated transverse and sigmoid sinus thrombosis is rarer and reported only once previously. We present a case of Graves disease, who suffered unilateral sigmoid and transverse sinus thrombosis with intracranial hemorrhage. A 42-year-old female, a diagnosed case of Graves disease, presented to us with headache, drowsiness, and hemiparesis. Computed Tomography revealed a large right temporo-parieto-occipital venous infarct. The patient needed surgical intervention in the form of decompressive craniotomy following which she improved, and on follow-up is having no deficits. Thrombophilia profile showed a low Protein S and Anti thrombin III (AT III) levels. Deranged thrombophilia profile in combination with the hypercoagulable state in thyrotoxicosis, most likely precipitated the thrombotic event. Timely surgical intervention can be offered in selective cases with a good clinical outcome.

Keywords: Cerebral sinus thrombosis; decompressive craniotomy; factor S deficiency; graves disease; thyrotoxicosis.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Plain axial CT scan shows a large right sided temporo-parieto-occipital hypodense area with foci of hyper attenuation within, suggestive of hemorrhagic transformation. The right lateral ventricle is effaced and there is evidence of subfalcine herniation and midline shift
Figure 2
Figure 2
Post contrast axial CT scan on post operative day 5 showing extensive leptomeningeal and peripheral enhancement of the infarct. The mass effect has decreased but the occipital horn is still mildly effaced
Figure 3
Figure 3
MRI 3 weeks after surgery showing peripheral and gyriform enhancement in the area of venous infarct. The infarct is well matured and there is no mass effect
Figure 4
Figure 4
Delayed MR venography (6 months post op) showing recanalization of right sigmoid and transverse sinus with development of significant collaterals. The longer, thinner arrow shows the collaterals and the shorter, stouter arrow indicates the recanalized sigmoid sinus
See this image and copyright information in PMC

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