Exogenous Testosterone and Estrogen Blocker-Associated Venous Thrombosis Presenting With Acute Aphasia: A Case Report

Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that often presents with vague or subacute neurological symptoms that make timely diagnosis challenging. We describe the case of a 52-year-old male patient who presented with an acute onset of aphasia, a left-sided headache, and visual field deficits. Initial non-contrast computed tomography (CT) imaging was unremarkable, but subsequent magnetic resonance venography (MRV) confirmed a thrombosis in the left transverse and sigmoid sinuses. The patient had been started on testosterone replacement therapy (TRT) and estrogen blockers six weeks prior to symptom onset. Laboratory studies revealed elevated hemoglobin, hematocrit, and testosterone levels, which were suggestive of erythrocytosis and increased blood viscosity. Imaging also revealed congenital hypoplasia of the V4 segment of the left vertebral artery. This variant may have contributed to altered cerebral hemodynamics. The patient was treated initially with intravenous heparin and transitioned to apixaban, a direct oral anticoagulant (DOAC). The outcome was favorable, with a full resolution of symptoms just three days after admission. This case highlights the importance of maintaining a high clinical suspicion for CVT in patients with non-specific neurological complaints, especially when prothrombotic risk factors such as recent hormone therapy are present. It also underscores the diagnostic value of contrast-enhanced imaging modalities and supports the use of DOACs as an effective treatment option for CVT.