AACE endocrinology and diabetes · 2025
Isolated Cortical Vein Thrombosis in a Young Woman on Transdermal Ethinyl Estradiol: Case Report and Literature Review.
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Ramadan Sara, Okda Mohamed, Kansal Dhruv, Thompson Bradford
Аннотация
BACKGROUND/OBJECTIVE: Cerebral venous thrombosis is an uncommon cause of stroke, often affecting young women and frequently associated with prothrombotic factors such as exogenous hormones. Estrogen therapy, used in contraception or hormone replacement, is a known risk factor for thrombosis. Although transdermal estrogen is thought to confer lower thrombotic risk than oral formulations, it is not risk-free. We report a case of isolated cortical vein thrombosis in a young woman on a transdermal estradiol patch.
CASE REPORT: A 32-year-old woman on a low-dose transdermal estradiol patch for contraception presented with acute headache, hemiparesis, and Wernicke's aphasia. Imaging revealed a left parietal infarction and thrombosis of a cortical vein in the left temporo-occipital region. The hypercoagulability work-up was unremarkable. She was treated with anticoagulation and supportive care, with gradual neurological improvement.
DISCUSSION: This case highlights that even transdermal estrogen, often considered safer, can contribute to cerebral venous thrombosis. Oral estrogen therapy substantially increases venous thromboembolism risk (2- to 4-fold), whereas transdermal 17β-estradiol has a lower impact on coagulation. Collaboration between endocrinology and neurology is vital in managing hormone-related thrombosis.
CONCLUSION: Isolated cortical vein thrombosis is a rare stroke etiology that can be precipitated by estrogen therapy. Transdermal estradiol bypasses hepatic first-pass metabolism, yet it is not devoid of thrombosis risk. Clinicians should remain vigilant in prescribing and monitoring hormone therapies, balancing benefits with individualized risk assessment. This case highlights the importance of recognizing endocrine factors in unusual thrombotic events and tailoring hormone regimens to minimize vascular complications.
CASE REPORT: A 32-year-old woman on a low-dose transdermal estradiol patch for contraception presented with acute headache, hemiparesis, and Wernicke's aphasia. Imaging revealed a left parietal infarction and thrombosis of a cortical vein in the left temporo-occipital region. The hypercoagulability work-up was unremarkable. She was treated with anticoagulation and supportive care, with gradual neurological improvement.
DISCUSSION: This case highlights that even transdermal estrogen, often considered safer, can contribute to cerebral venous thrombosis. Oral estrogen therapy substantially increases venous thromboembolism risk (2- to 4-fold), whereas transdermal 17β-estradiol has a lower impact on coagulation. Collaboration between endocrinology and neurology is vital in managing hormone-related thrombosis.
CONCLUSION: Isolated cortical vein thrombosis is a rare stroke etiology that can be precipitated by estrogen therapy. Transdermal estradiol bypasses hepatic first-pass metabolism, yet it is not devoid of thrombosis risk. Clinicians should remain vigilant in prescribing and monitoring hormone therapies, balancing benefits with individualized risk assessment. This case highlights the importance of recognizing endocrine factors in unusual thrombotic events and tailoring hormone regimens to minimize vascular complications.