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DOI: 10.1590/0004-282X-ANP-2021-0115
Malignant cerebral venous thrombosis in a transgender patient: intraoperative aspect of vein of Trolard thrombosis
Trombose venosa cerebral maligna em um paciente transgênero: aspecto intraoperatório da trombose da veia de Trolard
A 53-year-old male-to-female transgender patient on cross-sex hormone replacement therapy (HRT) presented with a one-day history of sudden onset aphasia and hemiparesis, preceded by a one-week complaint of headache. CT scan showed a large frontoparietal hematoma and venous CT displayed extensive filling defects of the venous sinus drainage system ([Figure 1]). The patient was submitted to an urgent decompressive surgery. Intra-operatory aspect revealed thrombosis of the Trolard vein ([Figure 2]).




Venous thrombosis events are a known complication related to HRT, although it appears to be rare[1],[2]. Our case emphasizes an unconventional risk factor for cerebral venous thrombosis and provides an illustrative correlation between neuroimaging and intraoperative findings.
Authors’ contributions:
CCBL, LRC, FF: contributed to patient neurological evaluation and data acquisition; VTGS, JEDCL, RHGY: contributed to patient neurosurgical evaluation and data acquisition; LTL: contributed to interpretation and discussion of neuroimaging findings. All authors contributed to the study conception and design, and all authors contributed in writing the main manuscript, which was critically reviewed by all.
Publication History
Received: 30 March 2021
Accepted: 06 May 2021
Article published online:
07 June 2023
© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Ott J, Kaufmann U, Bentz EK, Huber JC, Tempfer CB. Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy. Fertil Steril. 2010 Mar;93(4):1267-72. https://doi.org/10.1016/j.fertnstert.2008.12.017
- 2 Opaskar A, Scharf EL, Chilungu MW, Kelly AG. Transgender venous thrombosis. Neurol Clin Pract. 2017 Dec;7(6):531-3. https://doi.org/10.1212/CPJ.20210115202101150401