Common carotid arterial thrombosis associated with ulcerative colitis

Abstract

A 26-year-old woman with ulcerative colitis was transferred to our hospital with left hemiparesis due to cerebral infarction. Cervical ultrasonography and magnetic resonance imaging angiography revealed thrombosis at the right common carotid artery and the right internal carotid artery. Antithrombotic and anticoagulant therapies were commenced. After about 2 wk of the treatment, the frequency of her diarrhea increased. She underwent emergency subtotal colectomy, but 10 d later an abundant hemorrhage from the remnant rectum occurred, so the remnant rectum was resected and an ileal pouch anal anastomosis was performed. Antithrombotic and anticoagulant therapies were continued, but neither her neurological status nor magnetic resonance imaging angiography findings showed subsequent changes. She was discharged 3 mon after operation. This is a rare case of common carotid arterial thrombosis occurring as a complication of ulcerative colitis, in which antithrombotic and anticoagulant therapies are considered to provoke a deterioration of the patient's bowel disease.

Recurrent ischemic stroke in a patient with ulcerative colitis and high levels of lipoprotein (a)

“…Cerebral infarction associated with ulcerative colitis is particularly rare, but clinically important because of its high morbidity and mortality. Indeed, only a few cases involving cerebral arteries have been described so far [1][2][3].…”

“…The pathogenesis of thrombosis in IBD remains unclear even if platelet and coagulation cascade abnormalities, systemic inflammation, and the presence of other well recognized vascular risk factors, including hyperhomocysteinemia, are likely to play a key role in clot formation [1]. Cerebral venous sinus thromboses are uncommon but well recognized ulcerative colitis complications, whereas arterial thromboembolic events involving the brain circulation have been rarely described and occur more frequently during the active phase [2][3][4][5].…”

Extraintestinal Manifestations of Ulcerative Colitis

“…Treatment is similar to that of patients without IBD. Arterial thrombosis is a rare complication of UC and sites of thrombosis involving radial, brachial and common carotid arterial thrombosis have been reported (Braverman & Bogoch, 1978;Mikroulis et al, 1999;Nogami et al, 2007). The pathogenesis of arterial thrombosis is related to increased fibrinogen levels, increased platelet counts, and decreased anti-thrombin III levels (Mikroulis, Antypas et al, 1999).…”

“…The pathogenesis of arterial thrombosis is related to increased fibrinogen levels, increased platelet counts, and decreased anti-thrombin III levels (Mikroulis, Antypas et al, 1999). Treatment with antithrombotic therapy can often worsen the UC and in patients who fail antithrombotic or anticoagulation therapies, colectomy is often necessary (Mikroulis, Antypas et al, 1999;Nogami, Iiai et al, 2007). UC has been reported to be associated with several vasculitides including: Takayasu's arteritis and giant cell arteritis (Jacob et al, 1990;Kawashima et al, 1999;Shibata et al, 2002).…”

Intra-Abdominal Venous and Arterial Thromboembolism in Inflammatory Bowel Disease

“…55,58,62Y74 Arterial thromboembolic events occur much less frequently than venous thromboembolic complications in IBD, and may affect the cerebral, 75,76 retinal, 24Y26 coronary, 5,77 carotid, 78 splanchnic, iliac, renal, upper and lower limb arteries, or the aorta. 9,79Y97 The decision-making process for the treatment of intraabdominal venous and arterial thromboemolic complications in IBD may be very challenging for several reasons: 1) no standardized therapies are available; 2) the decision of starting anticoagulant therapy implies the potential risk of intestinal bleeding; 3) thromboembolic events may recur 7,12 and be life-threatening if inadequately treated.…”