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Cerebral venous sinus thrombosis in a patient with polycystic ovary syndrome

  • Author Footnotes
    ⁎ These authors contributed equally to this work.
    Yanqi Shao
    Footnotes
    ⁎ These authors contributed equally to this work.
    Affiliations
    Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China 310014
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  • Author Footnotes
    ⁎ These authors contributed equally to this work.
    Xinyi Gao
    Footnotes
    ⁎ These authors contributed equally to this work.
    Affiliations
    School of Medicine, Hangzhou Normal University, Zhejiang, China, 310018

    Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China 310014
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  • Peng Wang
    Affiliations
    Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China 310014
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  • Xiaodong He
    Affiliations
    Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China 310014
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  • Yu Geng
    Correspondence
    Corresponding author: Dr. Yu Geng, Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China 310014
    Affiliations
    Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China 310014
    Search for articles by this author
  • Author Footnotes
    ⁎ These authors contributed equally to this work.
Published:September 01, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.08.007
      Cerebral venous sinus thrombosis is an uncommon but serious form of venous thromboembolism. Approximately 70% of patients with cerebral venous sinus thrombosis are women; women of childbearing age were shown to have the highest incidence of any demographic (2.78 per 100,000 person-years).
      • Coutinho JM
      • Zuurbier SM
      • Aramideh M
      • Stam J.
      The incidence of cerebral venous thrombosis: A cross-sectional study.
      Polycystic ovary syndrome, the most prevalent endocrinopathy in women of reproductive age, characterized by excess androgen and irregular menstruation, has also been associated as a risk factor for venous thromboembolism.
      • Gariani K
      • Hugon-Rodin J
      • Philippe J
      • Righini M
      • Blondon M
      Association between polycystic ovary syndrome and venous thromboembolism: A systematic review and meta-analysis.
      For cases with associated hyperandrogenism, combined oral contraceptives (COCs) of estrogen and progestin are the first-line recommendation to regulate their menstrual cycle and reduce active androgen levels, thereby ameliorating clinical symptoms caused by hormonal disturbances.
      • Legro RS
      • Arslanian SA
      • Ehrmann DA
      • et al.
      Diagnosis and treatment of polycystic ovary syndrome: An endocrine society clinical practice guideline.
      According to a recent meta-analysis, women taking COCs have a 7.59-fold increased risk of developing cerebral venous sinus thrombosis as compared to women who do not take COCs (95% CI: 3.82–15.09).
      • Amoozegar F
      • Ronksley PE
      • Sauve R
      • Menon BK.
      Hormonal contraceptives and cerebral venous thrombosis risk: A systematic review and meta-analysis.
      The most frequently affected sinuses are the superior sagittal and transverse sinuses, followed by the internal jugular and cortical veins.
      • Capecchi M
      • Abbattista M
      • Martinelli I.
      Cerebral venous sinus thrombosis.
      In cases of central venous sinus thrombosis but without contraindications for anticoagulation, low molecular weight heparin (LMWH) should be prescribed regardless of the presence of intracranial hemorrhage. Meanwhile, patients whose symptoms worsen despite intensive anticoagulation might be considered for emergent endovascular interventions, including intra-sinus thrombolysis, mechanical thrombectomy, and angioplasty.
      • Saposnik G
      • Barinagarrementeria Jr, F
      • et al.
      Diagnosis and management of cerebral venous thrombosis: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

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