Superior Sagittal Venous Sinus Thrombosis in a Patient with Illicit Testosterone Use

• Published in: Curēus (Palo Alto, CA) Vol. 11; no. 8; p. e5491
• Main Authors: Hashmi, Ariba, Kim, Paul, Ahmad, Syed W, Faucheux, Jason, Gandikal, Naz
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 26-08-2019; Cureus
• Subjects: Androgens; Antibiotics; Blood clots; Case reports; Convulsions & seizures; Endocrinology/Diabetes/Metabolism; Etiology; Family medical history; Hormone replacement therapy; Mutation; Neurology; Patient education; Pneumonia; Primary care; Radiology; Sinuses; Stroke; Testosterone; Thrombosis; United States > US; cord sign; anabolic steroids; hypercoagulability; delta sign; superior sagittal sinus; general tonic-clonic seizures; testosterone replacement therapy; cerebral venous sinus thrombosis; androgenic anabolic steroids; coagulation
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.5491

Cerebral venous sinus thrombosis is a challenging diagnosis due in part to its variable clinical presentation and rarity. The annual incidence ranges from 0.22 to 1.57 per 100,000. The etiology of such disease is related to hypercoagulability states. Although illicit androgen use is a well-known cause of prothrombotic states, its risk of causing cerebral venous sinus thrombosis has been infrequently reported. We present the case of a 33-year-old male with no known past medical history who presented to the emergency department (ED) with persistent seizure activity, neurological deficits, and history of worsening headaches who was found to have an extensive superior sagittal sinus thrombosis on imaging. Radiologic findings demonstrated pathognomonic findings of cord sign and delta sign, the previous being highly specific but of low incidence. An inconclusive hypercoagulability workup prompted further questioning which revealed illicit androgenic anabolic steroid use. Prompt treatment with anticoagulation and anti-seizure medication was pursued with full resolution of his neurologic symptomatology.