Case Report
Cerebral Dural Sinus Thrombosis Associated with Adenomyosis: A Case Report

https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.01.027Get rights and content

We report a case of cerebral venous thrombosis (CVT) associated with a giant adenomyosis. At admission, the patient demonstrated generalized seizures and consciousness disturbance. Brain fluid–attenuated inversion recovery magnetic resonance imaging revealed a localized, high-intensity region in the left frontal lobe. Subsequent brain angiography showed that right internal carotid angiograms display abrupt termination of the anterior half of the superior sagittal sinus and a filling defect in the lateral part of the left transverse sinus. The patient complicated with iron deficiency anemia (IDA) and adenomyosis with higher levels of serum carbohydrate antigen 125 (CA125) and d-dimer. After 1 year from onset, intermittent severe menalgia and headache persisted, and blood examination revealed abnormal values; the patient was receiving oral medications. Finally, adenomyosis resection was performed with a favorable outcome, and no recurrence was observed during the 2-year follow-up period. We conclude that IDA and increased CA125 levels may have promoted hypercoagulability and CVT. This report emphasizes the possible relationship between CVT and adenomyosis.

Introduction

Cerebral venous thrombosis (CVT) is an infrequent cerebrovascular disease, with an estimated incidence of .5% among all strokes.1, 2 Causes of CVT are heterogeneous.1 We report a case of adenomyosis-associated dural sinus thrombosis complicated by iron deficiency anemia (IDA) and increased serum carbohydrate antigen 125 (CA125) levels. We propose adenomyosis as a possible cause of CVT and briefly discuss its development.

Section snippets

Case Presentation

A 47-year-old woman experienced a sudden onset of generalized seizures. At presentation, the patient was somnolent and complained of headache. Her blood pressure was 106/70 mm Hg. She had no history of hypertension, diabetes, or dyslipidemia and had not been a habitual smoker. Her medical history was remarkable for adenomyosis. She was not pregnant or taking contraceptives. Ophthalmologic examination revealed no abnormalities in the optic fundi. However, brain fluid–attenuated inversion

Discussion

To our knowledge, ours is the first case of CVT associated with adenomyosis. We previously reported 4 adenomyosis cases complicated by cerebral infarction.3 Adenomyosis rarely causes cerebral embolism with increase in d-dimer and CA125 levels. In addition to ovarian cancer, CA125 is a marker of benign ovarian tumors, myoma uteri, and adenomyosis.4 CA125 is a mucinous protein that can promote blood hypercoagulability.5 Recently, several reports have suggested a strong association between CVT and

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Conflicts of interest: The authors declare no financial or other conflicts of interest.

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