An unusual association between acute ischaemic stroke and cerebral venous thrombosis with thyrotoxic state

Arterial cerebral ischaemia has been described in different diseases of the thyroid. Likewise, cerebral venous thrombosis (CVT) has been reported in association with hyperthyroidism. However, the association of arterial and venous cerebral ischaemic events in patients with hyperthyroidism has not be...

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Bibliographic Details
Published in:BMJ case reports 2013-12, Vol.2013, p.bcr2013201130
Main Authors: Janovsky, Carolina Castro Porto Silva, Fukuda, Thiago G, Silva, Gisele S, Martins, João Roberto M
Format: Article
Language:English
Subjects:
Aphasia
Decompressive Craniectomy
Diagnosis, Differential
Diagnostic Imaging
Female
Humans
Hyperthyroidism
Immunoglobulins
Intracranial Thrombosis - diagnosis
Intracranial Thrombosis - etiology
Intracranial Thrombosis - surgery
Mortality
South/Central America
Stroke
Stroke - diagnosis
Stroke - etiology
Stroke - surgery
Thrombosis
Thyroid gland
Thyrotoxicosis - complications
Thyrotoxicosis - diagnosis
Thyrotoxicosis - drug therapy
Unusual Association of Diseases/Symptoms
White
Young Adult
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Summary:Arterial cerebral ischaemia has been described in different diseases of the thyroid. Likewise, cerebral venous thrombosis (CVT) has been reported in association with hyperthyroidism. However, the association of arterial and venous cerebral ischaemic events in patients with hyperthyroidism has not been previously described. We report the case of a patient with thyrotoxicosis who presented initially with an arterial ischaemic stroke complicated by a concomitant CVT, ultimately treated with decompressive craniectomy. Laboratory results revealed elevated factor VIII coagulant activity and a positive lupus anticoagulant IgG. In conclusion, CVT and arterial ischaemic events can happen concomitantly in patients with hyperthyroidism. Although there is insufficient evidence to prove that a hypercoagulability state in hyperthyroidism predisposes to cerebral ischaemia, the presence of antiphospholipid antibodies and other hypercoagulability studies should be performed in patients with thyrotoxicosis and ischaemic events.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2013-201130