Thyrotoxic hypercoagulable state with cerebral venous thrombosis and venous infarction masquerading as epilepsia partialis continua

Abstract

Physical examination showed sinus tachycardia (heart rate-115 beats/min), warm clammy skin, left upper extremity weakness of a pyramidal pattern and left-sided facial sensory impairment to touch and pin prick over the V1 and V2 distribution. Contrast-enhanced brain magnetic resonance imaging revealed a filling defect in the superior sagittal sinus and a small right frontal hemorrhagic infarct [Figure 2]a and b. Magnetic resonance venography (MRV) of the brain revealed extensive sub-acute superior sagittal and transverse sinus thrombosis [Figure 2]c and d. Endocrinological work-up revealed severe thyrotoxicosis (undetectable thyroid stimulating hormone <0.005 mIU/L, high T3 at 209 ng/dL [N = 58-159 ng/dL], high free T3 at 17.6 pg/mL [N = 2-4.4 pg/mL] and high free T4 at 18.6 [mu]g/dL [N = 4.5-12.0 [mu]g/dL]).