Central Venous Thrombosis a Rare Complication of Ulcerative Colitis: A Case Report

Abstract

SESSION TITLE: Fellow Case Report Poster - Critical Care II SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Ulcerative colitis is a chronic inflammatory bowel disease of unknown etiology. In a multinational, multicenter trial inflammatory bowel disease accounted for 1.6% of causes of central venous thrombosis (1) Here we report the case of a patient with Ulcerative Colitis with paresthesias who was found to have a dural sinus and cerebral cortical vein thrombosis. CASE PRESENTATION: A 25 year old male with ulcerative colitis (UC) presented with complaints of left hand numbness, which began 12 hours prior. The patient said that his left side from neck to fingers felt as if it was asleep. The sensation had started in his fifth finger then progressed throughout his hand. He also complained of left chest tingling. Initial vital signs were significant for a temperature of 102, HR 102. Cranial nerves were intact and extremity strength was full bilaterally. Sensation was decreased to light touch over left arm. 12 hours after presentation the patient found he was unable to move his left leg, and 18 hours after presentation he was unable to lift his arm and leg against gravity. MRI was significant for dural venous sinus thrombosis involving the confluence of sinuses and cerbral cortical vein. DISCUSSION: Dural sinus and cerebral cortical vein thromboses are rare complications of ulcerative colitis. (2) Subtle neurologic presentation and failure to make early diagnosis can result in fatal outcomes. (3) The pathogenesis of this complication remains unknown, and is attributed to the hypercoagulable state associated with inflammatory disease. This particular patient had recent infection, and poorly controlled UC. Thrombosis has been reported to more frequently occur in patient during relapse. (2) CONCLUSIONS: Central venous thromboses can be associated with ulcerative colitis, and can present initially with very mild neurological complaints, including paresthesias as was the case with our patient. A high clinical suspicion is necessary in order to start anticoagulation early to avoid fatal neurologic outcome. Reference #1: Ferro JM, et al. 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. Reference #2: Cognat E, et al.Cerebral venous thrombosis in inflammatory bowel diseases: eight cases and literature review. Int J Stroke. 2011 Dec;6(6):487-92. doi: 10.1111/j.1747-4949.2011 Reference #3: Nudelman RJ et al. Cerebral sinus thrombosis: a fatal neurological complication of ulcerative colitis.Patholog Res Int. 2010 Apr 29;2010:13275 DISCLOSURE: The following authors have nothing to disclose: Abigail Chua, Evgeny Pinelis No Product/Research Disclosure Information