Cerebral Venous Thrombosis during Thyrotoxicosis: Case Report and Literature Update

Abstract

Cerebral venous thrombosis (CVT) is a rare cause of stroke, particularly in young adults. Several known thrombophilic conditions may lead to an increased CVT risk. Interestingly, few cases in the literature have reported an association between CVT and thyrotoxicosis. Here, we describe the case of a young woman with CVT and concomitant thyrotoxicosis, without any other known prothrombotic conditions. We also performed a literature review of CVT cases and hyperthyroidism, searching for all articles published in peer-reviewed journals. We identified 39 case reports/case series concerning patients with CVT associated with thyrotoxicosis, highlighting, in most cases, the association with additional known prothrombotic factors. We then discussed the possible mechanisms by which hyperthyroidism could underlie a pro-coagulative state resulting in CVT. Thyroid disease might be a more common prothrombotic risk factor than expected in determining CVT. However, in most cases, a coexistence of multiple risk factors was observed, suggesting a multifactorial genesis of the disorder. We hope that this work may alert clinicians to consider thyrotoxicosis as a potential risk factor for CVT, even in patients who apparently have no other pro-coagulative conditions.

Keywords: cerebral veins; cerebral venous sinuses; cerebral venous thrombosis (CVT); hyperthyroidism; prothrombotic state; stroke; thyroid disease; thyroid storm.

Figure 1

(a,b) Maximum intensity projection (MIP) post-contrast CT-venography reconstruction showing the ‘empty delta’ sign, i.e., occlusion of the confluence of sinuses (see arrows).

Figure 2

(a–d) Brain MRI. Diffusion-weighted imaging (DWI) (a), Fluid Attenuated Inversion Recovery (FLAIR) sequences showing (b,c) small multifocal acute ischemic lesions, and (d) spontaneous hypersignal of Vein of Galen suggesting thrombosis (arrow).

Figure 3

(a–d) Brain MRI. (a,b) Venous 3D MIP phase contrast (PC), (c,d) 3D contrast-enhanced T1-weighted images showing a complete recanalization of the previously involved venous sinuses (see arrows).

Figure 4

(a) The graphs show the main demographic and clinical characteristics of the described patients. (b) The graph shows the prevalence of coagulopathies in the described patients.