An unusual association between acute ischaemic stroke and cerebral venous thrombosis with thyrotoxic state

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.