A case of cerebral venous sinus thrombosis in a male-to-female transsexual taking oral contraceptives

• Published in: Japanese Journal of Stroke Vol. 32; no. 2; pp. 179 - 184
• Main Authors: Shibata, Ken-ichi, Yamashita, Taiji, Nagano, Sukehisa, Yoshimura, Takeo
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 2010
• Subjects: androgen; cerebral venous sinus thrombosis; estrogen; heparin
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.32.179

We report a case of cerebral venous sinus thrombosis in a 40-year-old Japanese male who had undergone sexual assignment surgery 13 years previously. One month before admission he began taking oral contraceptives to aid in his feminization. Then two days before he came to our hospital, he suffered a headache that progressively worsened. On admission, he showed a mild disturbance of consciousness and a slight increase in his blood coagulation. A head MR venogram showed that the left transverse sinus was occluded and the right highly stenotic, indicating venous sinus thrombosis. Local thrombolysis using a total dose of 480,000IU of urokinase was not successful. Anticoagulant therapy with heparin was continued despite hemorrhagic infarction, and resulted in the recanalization of the venous sinuses. Risk of venous thrombosis from oral contraceptive use is well known. Combinatory use of oral contraceptives and anti-androgen drugs has been shown to be a higher risk factor than that from oral contraceptive use alone. This is the first report of cerebral venous sinus thrombosis in a patient after a male-to-female transsexual surgery. It should be pointed out that testicle removal, one of the anti-androgen therapies, is also a risk factor.