Intest Res.  2016 Jan;14(1):96-101. 10.5217/ir.2016.14.1.96.

Cerebral venous thrombosis in a patient with Crohn's disease

• Cho YH
• Chae MK
• Cha JM
• Lee JI
• Joo KR
• Shin HP
• Baek IH
• Jeon JW
• Lim JU
• Hong IT
• Ki HJ
• Kang JB

• KMID: 2174516
• DOI: http://doi.org/10.5217/ir.2016.14.1.96

Abstract

Patients with inflammatory bowel disease (IBD) have an elevated risk of venous thromboembolism compared with the general population. The most common sites of venous thromboembolism in IBD patients are the deep veins of the legs, the pulmonary system, and portal and mesenteric veins. However, cerebral venous thrombosis is rarely associated with IBD. This report describes a case of cerebral venous thrombosis in a patient with Crohn's disease. A 17-year-old girl, diagnosed 4 years earlier with Crohn's disease, presented with headache and vomiting. Magnetic resonance imaging of the brain with venography showed venous thrombosis in the cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. The patient immediately started anticoagulation therapy with intravenous heparin infusion followed by daily oral rivaroxaban 10 mg. Follow-up imaging after 2 weeks showed resolution of the thrombosis, with recanalization of the cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. She continued rivaroxaban therapy for 6 months, and remained well, without neurologic sequelae. A high level of concern for cerebral venous thrombosis may be important when treating active IBD patients, because anticoagulation treatment can prevent fatal complications.

Keyword

Inflammatory bowel diseases; Crohn disease; Cerebral venous thrombosis; Complication; Anticoagulation

MeSH Terms

Adolescent
Brain
Crohn Disease*
Female
Follow-Up Studies
Headache
Heparin
Humans
Inflammatory Bowel Diseases
Jugular Veins
Leg
Magnetic Resonance Imaging
Mesenteric Veins
Phlebography
Rivaroxaban
Superior Sagittal Sinus
Thrombosis
Veins
Venous Thromboembolism
Venous Thrombosis*
Vomiting
Heparin

Figure

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  Fig. 1 Endoscopic findings. Endoscopic findings show the longitudinal ulcers (A) A B with cobble stone appearance (B).

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  Fig. 2 Brain CT findings. The CT shows hyperattenuation segments at the anterior and medial superior sagittal sinus (A), right transverse sinus (B, arrow), and cortical veins (B, arrowhead).

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  Fig. 3 Brain MRI with venography. Magnetic resonance venography shows venous thrombosis in the cortical veins (B, thin arrow), superior sagittal sinus (A, arrowheads), right transverse sinus (B, arrow), and right internal jugular vein (B, arrowhead).

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  Fig. 4 Follow-up brain CT after 7 days of anticoagulation. Follow up CT shows resolution of dense attenuation within the superior sagittal sinus (A), right transverse sinus (B, arrow), and cortical veins (B, arrowhead).

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  Fig. 5 Follow-up brain MRI with venography after 2 weeks of anticoagulation. Follow up MRI with venography shows resolved venous thrombosis with recanalization of the cortical veins (B, thin arrow), superior sagittal sinus (A, arrowheads), right transverse sinus (B, arrow), and right internal jugular vein (B, arrowhead).

Reference

1. Bernstein CN, Blanchard JF, Houston DS, Wajda A. The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study. Thromb Haemost. 2001; 85:430–434. PMID: 11307809.

2. Talbot RW, Heppell J, Dozois RR, Beart RW Jr. Vascular complications of inflammatory bowel disease. Mayo Clin Proc. 1986; 61:140–145. PMID: 3080643.

3. Katsanos AH, Katsanos KH, Kosmidou M, Giannopoulos S, Kyritsis AP, Tsianos EV. Cerebral sinus venous thrombosis in inflammatory bowel diseases. QJM. 2013; 106:401–413. PMID: 23243293.

4. Kwon Y, Koene RJ, Cho Y. A case of cerebral venous sinus thrombosis associated with Crohn's disease: dilemma in management. Gastroenterol Rep (Oxf). [published online ahead of print November 10, 2014]. DOI: 10.1093/gastro/gou079.

5. Huh SY, Kim JK, Park SJ. Cerebral venous sinus thrombosis in a patient with Crohn disease. Kosin Med J. 2009; 24:190–192.

6. Chung C, Kang DH, Kim EA, et al. A case of pulmonary embolism in recurrent ileal Crohn's disease after total colectomy. Korean J Gastrointest Endosc. 2001; 22:111–115.

7. Chung ES, Kim JH, Jung JH, et al. A case of pulmonary thromboembolism in Crohn's disease. Tuberc Respir Dis. 2009; 66:370–373.

8. Kim W, Kang B, Kim BW, et al. Crohn's disease initially accompanied by deep vein thrombosis and ulnar neuropathy without metronidazole exposure. Gut Liver. 2013; 7:252–254. PMID: 23560164.

9. Oh DY, Jung HK, Kwon KJ, et al. Unusual complication of Crohn's disease: portal hypertension related with rapid progression of portal vein and superior mesenteric vein thrombosis. Korean J Med. 2013; 84:713–717.

10. Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010; 375:657–663. PMID: 20149425.

11. Papa A, Gerardi V, Marzo M, Felice C, Rapaccini GL, Gasbarrini A. Venous thromboembolism in patients with inflammatory bowel disease: focus on prevention and treatment. World J Gastroenterol. 2014; 20:3173–3179. PMID: 24695669.

12. Zezos P, Kouklakis G, Saibil F. Inflammatory bowel disease and thromboembolism. World J Gastroenterol. 2014; 20:13863–13878. PMID: 25320522.

13. Ye BD, Yang SK, Shin SJ, et al. Guidelines for the management of Crohn's disease. Korean J Gastroenterol. 2012; 59:141–179. PMID: 22387837.

14. Choi CH, Kim YH, Kim YS, et al. Guidelines for the management of ulcerative colitis. Korean J Gastroenterol. 2012; 59:118–140. PMID: 22387836.

15. Einhäupl K, Stam J, Bousser MG, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010; 17:1229–1235. PMID: 20402748.