Kosin Med J.  2016 Dec;31(2):179-183. 10.7180/kmj.2016.31.2.179.

A Case of Cerebral Venous Thrombosis in a Patient with Graves' Disease

• Kim BR
• Jung JH
• Hahm JR
• Jung J
• Park HJ
• Kim SK

• KMID: 2365243
• DOI: http://doi.org/10.7180/kmj.2016.31.2.179

Abstract

Superior sagittal sinus thrombosis is an uncommon disease, and 25% of cases are considered to be idiopathic. Hypercoagulability, local bloodstream stasis, and vessel wall abnormalities may contribute to the development of this condition. The thyrotoxic phase of Graves' disease is associated with venous thrombosis caused by hypercoagulability, which is in turn induced by increased levels of homocysteine and factor VIII and decreased fibrinolytic activity. Here, we report the case of a 39-year-old male who presented with superior sagittal sinus thrombosis and concomitant hyperthyroidism.

Keyword

Cerebral venous thrombosis; Thyrotoxicosis; Protein C Deficiency

MeSH Terms

Adult
Factor VIII
Graves Disease*
Homocysteine
Humans
Hyperthyroidism
Male
Protein C Deficiency
Superior Sagittal Sinus
Thrombophilia
Thrombosis
Thyrotoxicosis
Venous Thrombosis*
Factor VIII
Homocysteine

Figure

• 

  Fig. 1. Fluid-attenuated inversion recovery (FLAIR, A) and diffusion-2 weighted MR images(DWI, B) demonstrate multiple hyperintense lesions in both high frontal cortices (arrows). The lesions are more clearly demonstrated on DWI (B) than on FLAIR image (A).

• 

  Fig. 2. Brain computed tomography (CT) angiography shows segmental 2 occlusion of the superior sagittal sinus due to thrombosis (arrows).

Reference

References

1. Allroggen H, Abbott RJ. Cerebral venous sinus thrombosis. Postgrad Med J. 2000; 76:12–5.

2. Stam J. Cerebral venous and sinus thrombosis: incidence and causes. Adv Neurol. 2003; 92:225–32.

3. Squizzato A, Gerdes VE, Brandjes DP, Büller HR, Stam J. Thyroid diseases and cerebrovascular disease. Stroke. 2005; 36:2302–10.

4. Erem C, Ersoz HO, Karti SS, Ukinç K, Hacihasanoglu A, Değer O, et al. J Blood coagulation and fibrinolysis in patients with hyperthyroidism. Endocrinol Invest. 2002; 25:345–50.

5. Siegert CE, Smelt AH, de Bruin TW. Superior sagittal sinus thrombosis and thyrotoxicosis. Possible association in two cases. Stroke. 1995; 26:496–7.

6. Ra CS, Lui CC, Liang CL, Chen HJ, Kuo YL, Chen WF. Superior sagittal sinus thrombosis induced by thyrotoxicosis. Case report. J Neurosurg. 2001; 94:130–2.

7. Verberne HJ, Fliers E, Prummel MF, Stam J, Brandjes DP, Wiersinga WM. Thyrotoxicosis as a predisposing factor for cerebral venous thrombosis. Thyroid. 2000; 10:607–10.

8. Colleran KM, Ratliff DM, Burge MR. Potential association of thyrotoxicosis with vitamin B and folate deficiencies, resulting in risk for hyperhomocysteinemia and subsequent thromboembolic events. Endocr Pract. 2003; 9:290–5.

9. Coutinho JM, Zuurbier SM, Stam J. Declining mortality in cerebral venous thrombosis: a systematic review. Stroke. 2014; 45:1338–41.

10. Franchini M, Lippi G, Targher G. Hyperthy roidism and venous thrombosis: a casual or causal association? A systematic literature review. Clin Appl Thromb Hemost. 2011; 17:387–92.

11. Bensalah M, Squizzato A, Ould Kablia S, Menia H, Kemali Z. Cerebral vein and sinus thrombosis and hyperthyrodism: a case report and a systematic review of the literature. Thromb Res. 2011; 128:98–100.

12. Kim DD, Chunilal S, Young S, Cutfield R. A study of venous thrombosis incidence in patients with acute hyperthyroidism. Intern Med J. 2013; 43:361–5.

13. Lin HC, Yang LY, Kang JH. Increased risk of pulmonary embolism among patients with hyperthyroidism: a 5-year follow-up study. J Thromb Haemost. 2010; 8:2176–81.

14. Grine S, Charfi N, Kamoun M, Mnif F, Naceur BB, Rekik N, et al. Hyperthyroidism: A rare cause of pulmonary embolism: Report of two cases. Indian J Endocrinol Metab. 2013; 17:1104–7.

15. Squizzato A, Romualdi E, Büller HR, Gerdes VE. Clinical review: Thyroid dysfunction and effects on coagulation and fibrinolysis: a systematic review. J Clin Endocrinol Metab. 2007; 92:2415–20.

16. Lippi G, Franchini M, Targher G, Montagnana M, Salvagno GL, Guidi GC, et al. Hyperthyroidism is associated with shortened APTT and increased fibrinogen values in a general population of unselected outpatients. J Thromb Thrombolysis. 2009; 28:362–5.

17. Molloy E, Cahill M, O'Hare JA. Cerebral venous sinus thrombosis precipitated by Graves' disease and Factor V Leiden mutation. Ir Med J. 2003; 96:46–7.