Cerebral venous sinus thrombosis in patients with inflammatory bowel disease: a retrospective study

Abstract

Cerebral venous sinus thrombosis (CVST) is a rare and devastating complication of inflammatory bowel disease (IBD). Early diagnosis and prompt treatment could improve prognosis. The aim of our study was to investigate the clinical data and predictive factors of inflammatory bowel disease in patients with a diagnosis of CVST. All IBD patient data were collected from July 2013 and September 2020. Clinical data, predictive factors and prognosis were compared between IBD patients with CVST and the IBD control group. The incidence of CVST in our study was 0.48%. The mean age of IBD patients with CVST was 34.9 years. The average duration of IBD was 4 years when cerebrovascular events occurred. The clinical presentation of CVST included headache (73.1%), vomiting (30.8%), limb dysmetria (26.9%), speech impairment (11.5%), blurred vision (7.7%), epileptic seizures (7.7%) and drowsiness (3.8%). The most common location for CVST was the transverse sinus (61.5%) followed by the superior sagittal sinus (30.8%). Anaemia, low albumin and elevated d-dimer were independent predictors of CVST in patients with IBD. Anticoagulation therapy was effective. The prognosis of IBD patients with CVST was worse than that of IBD patients without CVST. Early identification of the risk and clinical features of CVST in IBD patients is important. Prompt antithrombotic therapy is a safe and effective treatment.

Case Report of Cerebral Venous Sinus Thrombosis Complication after Microvascular Decompression Surgery in the Inactive Phase of Ulcerative Colitis

“…Aishah Ibrahim Albakr and Noor Almohish analysed risk factors for CVST in patients with IBD and pointed at corticosteroid therapy, anemia, previous thrombotic events, inherited thrombophilia, high homocysteine level, hormonal therapy, and post-operative condition [6]. Another study added D-dimer level as a risk factor [5]. Owczarek et al mention acquired prothrombotic factors in Inflammatory Bowel disease dehydration, glucocorticosteroid therapy, prolonged immobilization, central venous catheters, surgical procedures, oral contraceptives/hormonal replacement therapy, smoking and hyperhomocysteinemia [4].…”

“…It is more often for thrombosis to occur in active IBD conditions, but occasionally that can be seen during remission [5]. Control of disease activity is an important factor in reducing the risk of venous and arterial thrombotic events in patients with IBD [8].…”

“…Most VTE events occur in the lower extremities or appear as pulmonary embolisms, but they can also occur in other locations such as hepatic, portal, cerebral, and mesenteric veins [2]. Cerebral venous sinus thrombosis (CVST) has a reported incidence between 0.5% -6.7% and is associated with a high mortality rate [5].…”

“…The clinical presentation of CVST includes headache, vomiting, seizure, focal neurological deficit, speech impairment, blurred vision, and drowsiness. One study reported that the most common location for CVST is the transverse sinus followed by sagittal, however other papers reported that the most common location for CVST is superior sagittal sinuses [5][6][7].…”

Cerebral Venous Thrombosis as an Initial Presentation of Ulcerative Colitis

“…Coagulation activity in UC has been found to be related to disease activity and colonic extension of the disease [ 14 ]. Additionally, anemia, thrombocytosis, low albumin, and elevated D-dimer levels have been suggested as significant risk factors for CVT [ 10 , 15 ]. Among these, severe iron deficiency anemia was identified as a significant risk factor for CVT in a previous study [ 16 ].…”