Cerebral venous sinus thrombosis with autoimmune thyroiditis
45-year-old female presented in emergency with complaints of headache since 1 month, vomiting since 1 day, and weakness with numbness and tingling in right half of body since 12 h. Her weakness progressed to quadriparesis overnight. She had no history of fever, head injury, seizures. No history of oral contraceptive use and prolonged immobilization. Her menstrual and obstetric history was unremarkable. On examination she was drowsy and disoriented. On neurological examination, reflexes were present and muscle tone was normal but power was 1/5 on right side and 3/5 in left half of body. Fundoscopy showed papilledema.\nNormal hemogram and renal and liver function tests. Thyroid function tests were suggestive of subclinical hypothroidism T3 - 0.94 ng/ml, T4 - 8.36 μg/dl, TSH - 13.92 mIU/ml. TPO antibodies were elevated (>1,300 IU/ml). Thrombophilia profile including prothrombin time index/international normalized ratio, serum homocysteine (5.6 mol/l), ANA, lupus anticoagulant, IgM and IgG cardiolipin antibodies, and APLA antibodies were negative. USG of thyroid showed bilateral bulky lobes with altered echotexture s/o thyroiditis. FNAC of thyroid nodule showed lymphocytic infiltration consistent with a diagnosis of Hashimoto thyroiditis. CT head showed hyperdensity in the region of superior sagittal sinus. MRI brain showed loss of flow void of superior sagittal and left transverse sinuses with altered signal appearing hyperintense on T1W and fluid-attenuated inversion recovery (FLAIR) images suggesting thrombosis.\nShe was put on heparin and warfarin. Her headache improved after 4 days of treatment and patient was discharged after 7 days with no residual neurological deficit.