Skip to main content

Cerebral Venous Thrombosis in a Young Athlete—an Unusual but Preventable Cause

Abstract

Evaluation of cerebral venous sinus thrombosis (CVST) can be challenging, with the etiology often being unrecognized. We report a case of CVST occurring secondary to anti-cancer medication abuse in a young bodybuilder. A 20-year-old male athlete with history of regular gym exercise presented with acute onset behavioral abnormalities and cognitive deficits. Brain magnetic resonance imaging (MRI) showed signal abnormalities in bilateral thalami, with venography showing venous thrombosis. A detailed history highlighted an unusual cause for CVST. Our report suggests that unsupervised drug abuse amongst young athletes is an overlooked and preventable cause of CVST. To the best of our knowledge, this is the first such report.

This is a preview of subscription content, access via your institution.

Fig. 1

Data Availability

Data used for the case report is available with the corresponding author.

Abbreviations

CVST:

cerebral venous sinus thrombosis

MRI:

magnetic resonance imaging

JE:

Japanese encephalitis

CSF:

cerebrospinal fluid

References

  1. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F, ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35:664–70.

    Article  Google Scholar 

  2. Martinelli I, Sacchi E, Landi G, Taioli E, Duca F, Mannucci PM. High risk of cerebral-vein thrombosis in carriers of a prothrombin-gene mutation and in users of oral contraceptives. N Engl J Med. 1998;338:1793–7.

    CAS  Article  Google Scholar 

  3. de Bruijn SF, Stam J, Koopman MM, Vandenbroucke JP. Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users and in carriers of hereditary prothrombotic conditions. The Cerebral Venous Sinus Thrombosis Study Group. BMJ. 1998;316:589.

    Article  Google Scholar 

  4. Willoughby DS, Taylor L. Effects of sequential bouts of resistance exercise on androgen receptor expression. Med Sci Sports Exerc. 2004;36(9):1499–506.

    CAS  Article  Google Scholar 

  5. Johnson RE, Murad MH. Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc. 2009;84:1010–5.

    Article  Google Scholar 

  6. Christoph R. Meier and Hershel Jick: tamoxifen and risk of idiopathic venous thromboembolism. Br J Clin Pharmacol. 1998;45:608–12.

    Article  Google Scholar 

  7. Saphner T, Tormey DC, Gray R. Venous and arterial thrombosis in patients who received adjuvant therapy for breast cancer. J Clin Oncol. 1991;9:286–94.

    CAS  Article  Google Scholar 

  8. McDonald CC, Alexander FE, Whyte BW, Forrest AP, Stewart HJ, for the Scottish Cancer Trials Breast Group. Br Med J. 1995;311:977–80.

    CAS  Article  Google Scholar 

  9. Jaillard AS, Hommel M, Mallaret M. Venous sinus thrombosis associated with androgens in a healthy young man [abstract]. Stroke. 1994;25:212–3.

    CAS  Article  Google Scholar 

  10. Sahraian MA, Mottamedi M, Azimi AR, Moghimi B. Androgen-induced cerebral venous sinus thrombosis in a young body builder: case report. BMC Neurol. 2004;4:22.

    Article  Google Scholar 

  11. Spano F, Ryan WG. Tamoxifen for gynecomastia induced by anabolic steroids? N Engl J Med. 1984;311:861–2.

    CAS  PubMed  Google Scholar 

  12. Parker LN, Gray DR, Lai MK, Levin ER. Treatment of gynecomastia with tamoxifen: a double-blind crossover study. Metabolism. 1986;35(8):705–8.

    CAS  Article  Google Scholar 

  13. Baker JS, Graham M, Davies B. Gym users and abuse of prescription drugs. J R Soc Med. 2006;99(7):331–2.

    Article  Google Scholar 

  14. Eggemann H, Bernreiter AL, Reinisch M, Loibl S, Taran FA, Costa SD, et al. Tamoxifen treatment for male breast cancer and risk of thromboembolism: prospective cohort analysis. Br J Cancer. 2019;120(3):301–5.

    CAS  Article  Google Scholar 

  15. Allasia S, Motta G, Mirabelli M, Tagliabue MP, Lanfranco F. A case of deep vein thrombosis in a young male treated with tamoxifen for idiopathic infertility. Asian J Androl. 2017;19(5):615–6.

    CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

SW analyzed and interpreted data regarding clinical treatment and outcome. AA analyzed and interpreted data regarding MRI. SJ and VP supervised the management of patient, and were major contributors to the preparation of manuscript.

Corresponding author

Correspondence to Siddharth Warrier.

Ethics declarations

Ethics Approval and Consent to Participate

Waived in view of observational nature of the case report.

Consent for Publication

Patient’s consent for use of data and publication of image received.

Competing Interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Medicine

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Warrier, S., Arora, A., Jha, S. et al. Cerebral Venous Thrombosis in a Young Athlete—an Unusual but Preventable Cause. SN Compr. Clin. Med. 3, 340–342 (2021). https://doi.org/10.1007/s42399-020-00664-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s42399-020-00664-8

Keywords

  • Cerebral venous sinus thrombosis
  • Young stroke
  • Tamoxifen
  • Athlete
  • Bodybuilder
  • Drug abuse