Report of a recurrent cerebral venous thrombosis in a young athlete

Abstract

BackgroundReports of occurrence of deep vein thrombosis during intensive sport are scarce. While a few cases have been described in the cerebral territory, these are only in the context of traumatism or anabolic agent consumption. Thus, causality with exercise remains uncertain and the mechanisms hypothetic. We present the case of a young athlete who experienced two episodes of severe cerebral venous thromboses (CVT), both during intensive training, in the absence of any other known thrombogenic factor.Case presentationA healthy 26-year-old man presented a thrombosis of the superior sagittal sinus during recent intensive training for a triathlon. Investigation at the time found no drug or anabolic steroid consumption, or any hematologic or coagulation disturbance. Anticoagulation therapy was initiated for 10 months with good outcome. One year later, soon after returning to intensive exercise, mainly running, the patient presented a thrombosis of the straight sinus complicated by bithalamic hyperintensities observed on T2 magnetic resonance imaging sequences. Anticoagulation treatment was reinitiated and led to repermeabilization of the cerebral vein and reversibility of thalamic abnormalities. Four months later, the patient was free of headache and had no cognitive impairment. He continues to practice intensive sport with vitamin K antagonist as preventive treatment.ConclusionThis is the first case report of recurrent CVT in a context of intensive sport, without any other thrombogenic features, suggesting a causal link. Intensive exercise should be considered as a potential promoting factor of CVT and investigated during routine examination.

Upper extremity deep vein thrombosis in a triathlete: Again intense endurance exercise as a thrombogenic risk

“…The few reports of venous thromboembolism occurring during a sports activity have been related to different sports activities [15][16][17], with a bigger incidence in long strenuous running as in a marathon [18], [4], or in a triathlon [6,7], meaning therefore, that effort induced deep vein thrombosis is a relatively well-studied event in sports medicine. However, the etiopathology of upper extremity deep vein thrombosis is not completely clear; the external compression and/or stress on the lining membrane of the axillary or subclavian veins due to postures or gestures associated with the retroversion and hyperabduction of the arm are possible causes [2].…”

Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review

“…The relationship between CVT and exercise remains unclear, but case reports have shown that high-intensity physical training may be associated with CVT. For example, Richard et al ( 2014 ) reported an athlete with recurrent CVT who developed thrombosis of the superior sagittal sinus during a marathon training session. The CVT manifested as headache, vomiting and diplopia.…”

Clinical aspects, diagnosis and management of cerebral vein and dural sinus thrombosis: A literature review

“…[63] Finally, although a case report has described recurrent CVST in relation to marathon training sessions, further studies are required to establish an association between strenuous exercise/physical activity and CVST. [64]…”