A case of cerebral venous sinus thrombosis secondary to hyperthyroidism

Abstract

A 43-year-old man was presented to our hospital with severe headache and seizures. A neurological examination revealed stupor and mild left hemiparesis. Head CT revealed a fresh infarction in the right parietal lobe and a hyperdensity spot in the posterior superior sagittal sinus (SSS). CT venography revealed the occlusion of the SSS. Since the patient had a history of Basedow disease, we examined the patient for hyperthyroidism, coagulation, and fibrinolytic system. His thyroid stimulating hormone (TSH) receptor antibody and thyroid stimulating antibody levels were found to have increased above normal levels (9.6 IU/l and 400%, respectively). The levels of von Willebrand (vW) factor and factor VIII procoagulant protein also showed a marked increase (>200% and 176.5%, respectively). Based on these findings, we made a diagnosis of cerebral venous sinus thrombosis due to Basedow disease. Hyperthyroidism should therefore be considered as a cause of cerebral venous sinus thrombosis. In addition, we should pay close attention to any changes in the levels of vW factor and factor VIII procoagulant protein. By doing so, it is possible to select the optimal treatment in a timely manner and predict the prognosis for patients with cerebral venous sinus thrombosis.