Cerebral venous thrombosis - ulcerative colitis

Case contributed by Dr Fateme Hosseinabadi

Presentation

Known case of ulcerative colitis with a history of one abortion and treated with azathioprine, presented with new-onset severe headache, photosensitivity and hemianopia.

Patient Data

Age: 25 years
Gender: Female

Noncontrast CT images show a large region of hypodensity and cytotoxic edema with blurring of the grey-white matter differentiation and gyral hyperdensity due to gyral hemorrhagic transformation and moderate mass effect on adjacent falx with effacement of the right occipital horn. Density of dural sinuses at initial imagings appear normal, that may be contributed to patient anemia (Hb:10 & HCT:29).

There is a large and restricted diffusion abnormal signal intensity at the right parietooccipital region with surrounding edema and mild to moderate mass effect and gyral hemorrhagic transformation with extension to adjacent sulci, more visible on FLAIR sequence compatible with subsequent SAH.

Filling defect and nonenhancement of the right transverse sinus and associated venous infarct and hemorrhagia is demonstrated. Adjacent meningeal enhancement is noted too.

Case Discussion

Cerebrovascular manifestations are seen in 0.12-4% of inflammatory bowel disease (IBD) patients and include CVST or arterial thrombosis, seizure, leukoencephalitis, and vasculitis. The incidence of thrombosis is about 6.5% in patients with active IBD.  The exact cause of thrombotic events in these patients is still uncertain, but recent research suggests that the inflammatory process can activate the coagulation cascade. Overall, patients with IBD have a 3.4 times higher risk of developing venous thromboembolism. CVT is an uncommon but serious neurological complication in ulcerative colitis that occurs during an episode of relapse. As a result of non-compromised arterial supply to the infarcted region, gyral hemorrhagic transformation is common.

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Case information

rID: 66049
Published: 8th Feb 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Zahedan medical university

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