Janovsky Carolina Castro Porto Silva, Fukuda Thiago G, Silva Gisele S, Martins João Roberto M
Department of Endocrinology, UNIFESP, Sao Paulo, Brazil.
BMJ Case Rep. 2013 Dec 5;2013:bcr2013201130. doi: 10.1136/bcr-2013-201130.
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.
动脉性脑缺血已在不同的甲状腺疾病中被描述。同样，脑静脉血栓形成（CVT）也已被报道与甲状腺功能亢进有关。然而，甲状腺功能亢进患者中动脉和静脉性脑缺血事件的关联此前尚未被描述。我们报告了一例甲状腺毒症患者，该患者最初表现为动脉缺血性卒中并伴有CVT，最终接受了减压颅骨切除术治疗。实验室结果显示因子VIII凝血活性升高以及狼疮抗凝物IgG呈阳性。总之，CVT和动脉缺血事件可在甲状腺功能亢进患者中同时发生。尽管没有足够的证据证明甲状腺功能亢进中的高凝状态易导致脑缺血，但对于患有甲状腺毒症和缺血事件的患者，应进行抗磷脂抗体检查及其他高凝状态研究。
