Abstract
Cerebral sinus thrombosis has been reported as an uncommon complication of ulcerative colitis (UC), occurring in up to 7.5% of cases. It is suspected to be a consequence of genetic predisposition and the hypercoagulable state occurring during disease relapse. We report a case of a 23-year-old male patient with one-year history of UC. He presented to the Emergency Room with left-sided progressive hemiparesis, numbness, hemiparesthesia, and pain, which followed a recent exacerbation of UC. The patient died 3 days after admission and an autopsy revealed superior and inferior sagittal sinus and cortical vein thrombosis with associated cerebral edema, hemorrhagic infarction, and herniation. The gastrointestinal tract had continuous cobblestone appearance extending from rectum to cecum, with hemorrhage and ulceration, consistent with active UC. Awareness of this rare complication of UC can contribute to early recognition and attempts at treatment of this serious and often fatal condition.
Highlights
Inflammatory bowel disease (IBD) comprises two major entities: ulcerative colitis (UC) and Crohn disease (CD)
Cerebral sinus thrombosis has been reported as an uncommon complication of ulcerative colitis (UC), occurring in up to 7.5% of cases
Cerebral vein and sinus thrombosis (CVST) has been reported as an uncommon but severe complication of UC and CD, ranging in frequency from 1.3% up to 7.5% of cases yearly depending on the clinical study [5]
Summary
Inflammatory bowel disease (IBD) comprises two major entities: ulcerative colitis (UC) and Crohn disease (CD). Ulcerative colitis is an idiopathic chronic IBD that is a consequence of complex interaction of environmental factors and genetic susceptibility [1] It often occurs in patients between the ages of 20 and 30 years, with a second peak between the ages of 70 and 80 years. Patients with IBD can develop a hypercoagulable state and have been noticed to have an increased risk of various thrombotic events. Cerebral vein and sinus thrombosis (CVST) has been reported as an uncommon but severe complication of UC and CD, ranging in frequency from 1.3% up to 7.5% of cases yearly depending on the clinical study [5]. We report the case of a 23-year-old Caucasian male with UC who succumbed to a massive superior and inferior sagittal sinus and cerebral cortical vein thrombosis followed by a large and fatal cerebral hemorrhagic infarct, which occurred in the setting of UC exacerbation
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