title: Progressive Ischemic Stroke due to Thyroid Storm-Associated Cerebral Venous Thrombosis.
abstract: BACKGROUND Cerebral venous thrombosis (CVT) is a rare but fatal complication of hyperthyroidism that is induced by the hypercoagulable state of thyrotoxicosis. Although it is frequently difficult to diagnose CVT promptly, it is important to consider it in the differential diagnosis when a hyperthyroid patient presents with atypical neurologic symptoms. CASE REPORT A 49-year-old Japanese female with unremarkable medical history came in with thyroid storm and multiple progressive ischemic stroke identified at another hospital. Treatment for thyroid storm with beta-blocker, glucocorticoid, and potassium iodide-iodine was started and MR venography was performed on hospital day 3 for further evaluation of her progressive ischemic stroke. The MRI showed CVT, and anticoagulation therapy, in addition to the anti-thyroid agents, was initiated. The patient's thyroid function was successfully stabilized by hospital day 10 and further progression of CVT was prevented. CONCLUSIONS Physicians should consider CVT when a patient presents with atypical course of stroke or with atypical MRI findings such as high intensity area in apparent diffusion coefficient (ADC) mapping. Not only is an early diagnosis and initiation of anticoagulation important, but identifying and treating the underlying disease is essential to avoid the progression of CVT.
authors.affiliation: Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
authors.forename: Natsumi
authors.initials: N
authors.lastname: Tanabe
authors.affiliation: Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Hiraoka
authors.affiliation: Department of Internal Medicine, Funabashi General Hospital, Funabashi, Chiba, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Hoshino
authors.affiliation: Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA.
authors.forename: Gautam A
authors.initials: GA
authors.lastname: Deshpande
authors.affiliation: Department of Neurosurgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
authors.forename: Kana
authors.initials: K
authors.lastname: Sawada
authors.affiliation: Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Norisue
authors.affiliation: Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
authors.forename: Jumpei
authors.initials: J
authors.lastname: Tsukuda
authors.affiliation: Department of Nephrology, Endocrinology, and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications*; D020767:Intracranial Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D007601:Jugular Veins; D020227:Lateral Sinus Thrombosis; D008875:Middle Aged; D011193:Potassium Iodide / Q000627:therapeutic use; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D013958:Thyroid Crisis / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D005938:Glucocorticoids; D011193:Potassium Iodide; D006493:Heparin