Isolated cortical vein thrombosis in an infertile male taking clomiphene citrate
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LETTER TO THE EDITOR
Isolated cortical vein thrombosis in an infertile male taking clomiphene citrate Jongsuk Choi 1 & Sanghoon Lee 2 & Chan-Nyoung Lee 1 Received: 21 June 2020 / Accepted: 26 October 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor, Clomiphene citrate (CC) is a selective estrogen receptor modulator that has been used to treat infertility in women who do not ovulate. However, it is now frequently used to treat men with infertility and/or hypogonadism. It is considered safe and has rarely been associated with serious side effect [1]. Common side effects of CC include hot flashes, mood swings, blurred vision, nausea, vomiting, and headaches. We report a case of an infertile man presenting with new-onset seizure after taking CC, who was finally diagnosed with cortical vein thrombosis. A 31-year-old man was referred to the neurology clinic because of his first generalized tonic-clonic seizure. Past medical history was unremarkable except for infertility due to azoospermia. He was taking low-dose CC (25 mg/day) in order to improve sperm count and motility for the last 3 months. Family and social history were noncontributory. The neurological examination was unremarkable. Brain magnetic resonance (MR) imaging showed abnormal lesions involving left high cortical sulci and prominent superficial cortical veins (Fig. 1a, b). MR angiography was normal. MR venography revealed an absence of vein of Trolard at the left hemisphere and patency of the major dural sinuses and deep veins, indicating isolated cortical vein thrombosis (Fig. 1c). The electroencephalogram was normal. The complete blood count and blood chemistry studies were unremarkable. Laboratory tests for hypercoagulability (activated partial thromboplastin time, prothrombin time, fibrinogen, antithrombin III, proteins C, protein S, factor V Leiden, prothrombin G20210A, activated protein C resistance, anti-
* Chan-Nyoung Lee [email protected] 1
Department of Neurology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
2
Department of Obstetrics and Gynecology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
phospholipid antibodies, anti-nuclear antibodies, anticardiolipin antibodies, lupus antibodies, and homocysteine) were performed prior to anticoagulation therapy and all values were within normal limits. Based on the diagnosis of cortical vein thrombosis, he received enoxaparin (1.5 mg/kg subcutaneously) with warfarin 3 mg daily for 5 days and switched to warfarin with the goal of maintaining the international normalized ratio of 2 to 3. Anticoagulation therapy with warfarin was continued for 3 months. Presuming CC as the probable risk factor, he was advised to stop taking CC and discuss with an infertility specialist. Follow-up brain MR imaging obtained approximately 3 months after the patient’s initial presentation showed interval resolution of the clot in the cortical vein (Fig. 1d). Warfarin was stopped, and he has subsequently done well without evidence of recurren
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