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Raho EM, Antonioni A, Cotta Ramusino N, Jubea D, Gragnaniello D, Franceschetti P, Penitenti F, Daniele A, Zatelli MC, Naccarato M, Traluci I, Pugliatti M, Padroni M. Cerebral Venous Thrombosis during Thyrotoxicosis: Case Report and Literature Update. J Pers Med 2023; 13:1557. [PMID: 38003871 PMCID: PMC10672691 DOI: 10.3390/jpm13111557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
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.
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Affiliation(s)
- Emanuela Maria Raho
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Annibale Antonioni
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Niccolò Cotta Ramusino
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Dina Jubea
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Daniela Gragnaniello
- Neurology Unit, Neurosciences and Rehabilitation Department, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Paola Franceschetti
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Francesco Penitenti
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Andrea Daniele
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Internal Medicine and Geriatrics, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | | | - Ilaria Traluci
- Neuroradiology Unit, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Maura Pugliatti
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy; (E.M.R.); (A.A.)
| | - Marina Padroni
- Neurology Unit, Neurosciences and Rehabilitation Department, Ferrara University Hospital, 44124 Ferrara, Italy
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Tashiro T, Kira Y, Maeda N. Hyperthyroidism-induced Cerebral Venous Thrombosis Presenting as Chronic Isolated Intracranial Hypertension. Intern Med 2023; 62:3021-3025. [PMID: 36792193 PMCID: PMC10641184 DOI: 10.2169/internalmedicine.1113-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/13/2022] [Indexed: 02/16/2023] Open
Abstract
A 38-year-old woman with untreated Graves' disease was admitted to our hospital because of headache and diplopia for 3 months. A neuro-ophthalmic examination showed bilateral papilledema and abducens nerve paralysis. The cerebrospinal fluid pressure was extremely high. Brain magnetic resonance imaging showed cerebral venous thrombosis in the superior sagittal and right transverse and sigmoid sinuses. Laboratory investigations revealed elevated factor VIII and von Willebrand factor levels. The patient recovered after propylthiouracil and anticoagulation therapy. We herein report a rare case of cerebral venous thrombosis with hyperthyroidism presenting as chronic isolated intracranial hypertension. Hyperthyroidism can induce a hypercoagulable state and lead to venous thromboembolism.
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Affiliation(s)
- Takumi Tashiro
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
| | - Yuichi Kira
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
| | - Norihisa Maeda
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
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Tanabe N, Hiraoka E, Hoshino M, Deshpande GA, Sawada K, Norisue Y, Tsukuda J, Suzuki T. Progressive Ischemic Stroke due to Thyroid Storm-Associated Cerebral Venous Thrombosis. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:194-197. [PMID: 28228636 PMCID: PMC5333713 DOI: 10.12659/ajcr.902297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Female, 49 Final Diagnosis: Cerebral venous thrombosis Symptoms: Altered mental state • weakness in limbs Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic
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Affiliation(s)
- Natsumi Tanabe
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Masataka Hoshino
- Department of Internal Medicine, Funabashi General Hospital, Funabashi, Chiba, Japan
| | - Gautam A Deshpande
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | - Kana Sawada
- Department of Neurosurgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Yasuhiro Norisue
- Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Jumpei Tsukuda
- Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Toshihiko Suzuki
- Department of Nephrology, Endocrinology, and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
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Waheed W, Aljerdi S, Decker B, Cushman M, Hamill RW. Cerebral venous thrombosis associated with thyrotoxicosis, the use of desmopressin and elevated factor VIII/von Willebrand factor. BMJ Case Rep 2016; 2016:bcr-2016-216584. [PMID: 27503942 DOI: 10.1136/bcr-2016-216584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cerebral venous thrombosis (CVT) is an uncommon disorder associated with diverse processes. We report a patient who, while receiving desmopressin and contraceptive pills (OCP), developed straight sinus thrombosis. Clinical assessment and laboratory investigations revealed untreated hyperthyroidism and a hypercoagulable state, characterised by high levels of von Willebrand factor, factor VIII coagulant activity and IgM cardiolipin antibody. The clinical picture improved with anticoagulation, treatment of hyperthyroidism and discontinuation of OCP and desmopressin. To the best of our knowledge, the association between the use of oral desmopressin and CVT has not been described. The multiple risk factors present in our case were probably additive in increasing the risk of CVT. Although this case represents a rare occurrence, practitioners should be alerted to the possible associations of desmopressin, oral contraceptives and Graves' disease with venous thrombosis.
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Affiliation(s)
- Waqar Waheed
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont, USA
| | - Salman Aljerdi
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont, USA
| | - Barbara Decker
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont, USA
| | - Mary Cushman
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Robert W Hamill
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont, USA
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