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Cerebral venous thrombosis in inflammatory bowel disease
Ersilia M DeFilippis1, Elaine Barfield, Dana Leifer
1Department of Gastroenterology and Hepatology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA.
Insights
Cerebral venous thrombosis (CVT) is a rare complication of inflammatory bowel disease (IBD). Early recognition of neurological symptoms during IBD flares is crucial for timely anticoagulation and improved outcomes.
Area of Science:
- Neurology
- Gastroenterology
- Vascular Medicine
Background:
- Inflammatory bowel disease (IBD) is associated with various extraintestinal manifestations.
- Cerebral venous thrombosis (CVT) is a rare but serious complication that can occur in IBD patients.
- Prompt diagnosis and management of CVT are essential for patient outcomes.
Observation:
- A case series of six IBD patients presenting with symptoms suggestive of CVT, including headache.
- Imaging confirmed cerebral venous thrombosis in all six patients.
- Four patients had ulcerative colitis, and two had Crohn's disease.
Findings:
- All six patients received therapeutic anticoagulation for CVT.
- Two deaths occurred: one due to coma and neurological decline, the other due to bowel perforation weeks after CVT recovery.
- Neurological symptoms in IBD patients, especially during flares, warrant high suspicion for CVT.
Implications:
- This case series highlights the importance of early neurological assessment in IBD patients experiencing flares.
- Timely initiation of anticoagulation therapy can potentially improve neurological outcomes in CVT patients with IBD.
- Increased awareness among clinicians is needed to reduce morbidity and mortality associated with CVT in IBD.
Abstract:
Cerebral venous thrombosis (CVT) is a rare but devastating complication of inflammatory bowel disease (IBD). Here we describe six IBD patients with cerebral venous thrombosis. The patients presented with hours to days of headache and were found to have venous thrombosis on imaging. Four of the six patients had ulcerative colitis and two had Crohn's disease. All six patients were treated with therapeutic anticoagulation. There were two deaths; one patient became comatose and died despite anticoagulation while the other recovered well from the sinus thrombosis but died after a bowel perforation 3 weeks later. This case series demonstrates the critical need for early recognition of neurological symptoms in patients with IBD during disease flares. It is important to recognize the clinical signs in order to start anticoagulation expeditiously and improve neurological outcomes.
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