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

Affiliations
  • 1Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea. drcha@khu.ac.kr

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

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

  • 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).

  • 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).

  • 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).

  • 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).


Cited by  2 articles

Use of Novel Oral Anticoagulant to Treat Pulmonary Thromboembolism in Patient with Ulcerative Colitis Superinfected Cytomegalovirus Colitis
Seok-Hwan Kim, Sunhee Jang, Yegyu Sung, Jun Kyu Park, Yunjung Park, Jintak Yun, Sang-Bum Kang
Korean J Gastroenterol. 2017;70(1):44-49.    doi: 10.4166/kjg.2017.70.1.44.

A case of ulcerative colitis presenting with cerebral venous thrombosis
Junghwan Lee, Sung Wook Hwang, Jinhee Lee, Kyung Hwa Jung, Ha Il Kim, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang
Intest Res. 2018;16(2):306-311.    doi: 10.5217/ir.2018.16.2.306.


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