J Cerebrovasc Endovasc Neurosurg.  2012 Sep;14(3):251-254. 10.7461/jcen.2012.14.3.251.

The Role of Hyperthyroidism as the Predisposing Factor for Superior Sagittal Sinus Thrombosis

• Hwang JU
• Kwon KY
• Hur JW
• Lee JW
• Lee HK

• KMID: 1808465
• DOI: http://doi.org/10.7461/jcen.2012.14.3.251

Abstract

Superior sagittal sinus thrombosis (SSST) is an uncommon cause of stroke, whose symptoms and clinical course are highly variable. It is frequently associated with a variety of hypercoagulable states. Coagulation abnormalities are commonly seen in patients with hyperthyroidism. To the best of our knowledge, there are few reports on the association between hyperthyroidism and cerebral venous thrombosis. We report on a 31-year-old male patient with a six-year history of hyperthyroidism who developed seizure and mental deterioration. Findings on brain computed tomography (CT) showed multiple hemorrhages in the subcortical area of both middle frontal gyrus and cerebral digital subtraction angiography (DSA) showed irregular intra-luminal filling defects of the superior sagittal sinus. These findings were consistent with hemorrhagic transformation of SSST. Findings on clinical laboratory tests were consistent with hyperthyroidism. In addition, our patient also showed high activity of factors IX and XI. The patient received treatment with oral anticoagulant and prophylthiouracil. His symptoms showed complete improvement. A follow-up cerebral angiography four weeks after treatment showed a recanalization of the SSS. In conclusion, findings of our case indicate that hypercoagulability may contribute to development of SSST in a patient with hyperthyroidism.

Keyword

Cerebral venous thrombosis; Superior sagittal sinus; Hyperthyroidism; Hypercoagulability

MeSH Terms

Adult
Angiography, Digital Subtraction
Brain
Cerebral Angiography
Follow-Up Studies
Hemorrhage
Humans
Hyperthyroidism
Male
Seizures
Stroke
Superior Sagittal Sinus
Thrombophilia
Thrombosis
Venous Thrombosis

Figure

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  Fig. 1 On initial brain computerized tomography (CT) scans, there are multiple hemorrhages in the subcortical area of both middle frontal gyrus (A, B).

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  Fig. 2 On follow-up brain CT scans, there are new onset foci and a slight increase of hemorrhage (A, B). CT angiography does not show any remarkable findings of major cerebral vessels (C, D).

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  Fig. 3 Initial digital subtraction angiography (DSA) shows irregular intra-luminal filling defects of the superior sagittal sinus (A, B).

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  Fig. 4 A follow-up DSA shows a recanalization of the superior sagittal sinus (A, B).

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