Abstract Details

Title Cerebral Venous Thrombosis: A Possible Complication of Clomiphene Therapy for in vitro Fertilization

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-003

Objective NA

Background Cerebral venous thrombosis is a cerebrovascular disorder with an estimated annual incidence of 3-4 cases per 1 million. It primarily affects young adults and children, causing venous infarction, cerebral edema and intraparenchymal hemorrhaging. Oral contraceptives, IVF therapy, pregnancy, puerperium, genetic prothrombotic conditions, malignancy, infections, and head trauma are risk factors. Patients may present with intracranial hypertension, encephalopathy, seizures and strokes.

Design/Methods NA

Results Case Presentation: A 35-year-old female with HTN, DM, and currently being treated with clomiphene for in vitro fertilization (IVF) presented to a nearby hospital with headache and left-sided numbness for a few days. She exhibited AMS and 0/5 strength on the left upper and lower extremities. CT head revealed intraparenchymal hemorrhages involving the right frontal and bilateral parietal lobes and hyperdensity of the superior sagittal sinus. She experienced a seizure prior to transfer. Upon arrival at our institution, MRV revealed thrombosis of the superior sagittal and bilateral transverse sinuses. Heparin drip was started with a PTT goal of 80-100. Neurosurgical intervention was not recommended. Hypercoagulable studies revealed decreased levels of antithrombin III, protein C and S, and was negative for factor V leiden variant. Later, she was switched to apixaban due to subtherapeutic PTT. Once stabilized, she was managed in acute in-patient rehabilitation. Follow-up at 5 weeks revealed significant functional improvement with increased strength to 4/5 in the left upper and lower extremities. The decreased levels of protein C, S, and antithrombin III are likely secondary to acute thrombosis. Therefore, the recent initiation of clomiphene was identified as the likely cause.

Conclusions Thromboembolism, especially cerebral thrombosis, is a dangerous complication of IVF treatment, as seen in this patient. It is important that clinicians work closely with fertility experts to reduce incidence of thrombosis as well as achieve early diagnosis to minimize lifelong complications.

Authors/Disclosures
Moises-Zacariah Garcia PRESENTER	Mr. Garcia has nothing to disclose.
Emily Liu	Ms. Liu has nothing to disclose.
Arthur Andrada, Jr.	Mr. Andrada has nothing to disclose.
	No disclosure on file

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