Cerebral Venous Sinus Thrombosis is a Reversible Complication of Ulcerative Colitis.

Hussain A Al Ghadeer,Shymaa Buhlaiqah,Sadeq A Alsalman,Zainab I Alabdi,Maryam M Aljumah,Sultan S Aljereish,Jaafer Alobaid

doi:10.7759/cureus.23099

Abstract

Patients with inflammatory bowel disease (IBD) are at higher risk of venous thrombosis than the general population, with thromboembolism being a recognized extraintestinal manifestation. Although thrombotic events typically present as deep vein thrombosis and pulmonary embolism, other presentations are possible. Cerebral venous sinus thrombosis (CVST) is a relatively rare example associated with high morbidity and a mortality rate of 50% when misdiagnosed or the diagnosis is delayed. Despite this, CVST is a reversible complication with favorable outcomes when diagnosed early and treated appropriately. In this report, we present a case of cerebral sinus thrombosis in a 35-year-old female during a relapse of ulcerative colitis. During the relapse of ulcerative colitis, CVST manifested with a seizure, focal neurological deficit, and altered mental status. After blood workup, magnetic resonance imaging (MRI), and venography, the diagnosis of CVST was confirmed. We immediately started the patient on low-molecular-weight heparin, and during a six-month follow-up period, she made a full recovery with recanalization of the thrombosis on imaging. Despite CVST being a fatal complication of IBD, our report and data in the literature indicate that full remission is possible when it is correctly diagnosed and treated.

Highlights

Inflammatory bowel disease (IBD) comprises Crohn’s disease, ulcerative colitis, and unclassified inflammatory bowel disease (IBD)
Cerebral venous sinus thrombosis (CVST) is a relatively rare example associated with high morbidity and a mortality rate of 50% when misdiagnosed or the diagnosis is delayed
We present a case of cerebral sinus thrombosis in a 35-year-old female during a relapse of ulcerative colitis

Summary

Introduction

Inflammatory bowel disease (IBD) comprises Crohn’s disease, ulcerative colitis, and unclassified IBD. A 35-year-old Saudi female with known ulcerative colitis, diagnosed at the age of 20, presented to our emergency department with a two-week history of bloody diarrhea She received regular gastroenterology follow-up, but she was prescribed azathioprine and mesalamine, compliance was poor. We discharged him here with regular follow-up and the following oral medications: 2 mg warfarin per day for 612 months (optimized to the international normalized ratio), 1 g 5-aminosalicylic acid three times daily, 35 mg prednisone daily tapering by 5 mg weekly, 50 mg azathioprine daily, 40 mg fluoxetine daily, 50 mg lamotrigine twice daily, 20 mg omeprazole, 5 mg folic acid daily, 5000 IU vitamin D weekly, and 600 mg calcium carbonate twice daily At six months, she had no residual neurological manifestations, and repeat MRI and MRV with and without contrast showed complete recanalization of the right-sided sphenoid parietal sinus and cortical veins (Figure 3A-3C). A breakthrough seizure occurred, most likely due to poor compliance with antiepileptic medication; full remission was observed with no recurrence or residual neurological deficit

Discussion

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Disclosures