Concurrent cerebral arterial and venous sinus thrombosis revealing celiac disease- a case report and literature review

Abstract

Background Celiac disease is an autoimmune condition characterized by an inappropriate immune reaction against gluten. It classically presents as chronic diarrhea, bloating, and nausea in addition to malabsorption symptoms such as weight loss and micronutrient deficiency. We report the first case of coinciding cerebral infarction and venous sinus thrombosis unveiling the diagnosis of celiac disease. Case presentation A 40-year old female patient with a four-day history of severe diarrhea presented with right hemiplegia and altered mental status. Imaging revealed left middle cerebral artery occlusion and left transverse and sigmoid venous sinus thrombosis, along with left jugular vein thrombosis. Her laboratory evaluation was notable for profound iron deficiency anemia, thrombocytosis, and hyperhomocysteinemia. Her positive anti-tissue transglutaminase IgA antibodies and ensuing duodenal biopsy confirmed the diagnosis of celiac disease. Conclusions Celiac disease has a wide range of intestinal and extraintestinal manifestations and can present with thrombotic events in young patients with iron deficiency and hyperhomocysteinemia.

Rare case of simultaneous cerebral artery and venous sinus thrombosis in the setting of elevated factor VIII and combined oral contraceptive pills

“…Simultaneous CVST and ischemic arterial infarcts have been reported before in the setting of profound iron deficiency anemia, thrombocytosis, hyperhomocysteinemia, and in patients with SARS‐CoV‐2 (COVID‐19) infection 3,4,6 . Bo‐Lin Ho et al 5 .…”

“…Simultaneous CVST and ischemic arterial infarcts have been reported before in the setting of profound iron deficiency anemia, thrombocytosis, hyperhomocysteinemia, and in patients with SARS‐CoV‐2 (COVID‐19) infection. 3 , 4 , 6 Bo‐Lin Ho et al 5 . reported a case of simultaneous CSVT and ischemic stroke in 41 years old with acquired protein C and protein S deficiency, iron deficiency anemia (IDA), and cryoglobulinemia, which were within normal in our patient.…”

“…2 CVST common risk factors encompass inherited and acquired prothrombotic conditions like hormonal therapy, malignancy, infection, and trauma-related injuries.Simultaneous cerebral arterial and venous infarction has been reported in very few case reports with homocysteinemia and acquired thrombophilia. [3][4][5][6] To the best of our knowledge, this is the first case of concurrent CVST and PICA ischemic stroke in a young female patient on COCP found to have elevated factor VIII.…”

“…Simultaneous cerebral arterial and venous infarction has been reported in very few case reports with homocysteinemia and acquired thrombophilia. [3][4][5][6] To the best of our knowledge, this is the first case of concurrent CVST and PICA ischemic stroke in a young female patient on COCP found to have elevated factor VIII.…”

Celiac Disease and Thrombotic Events: Systematic Review of Published Cases

“…Less common thrombosis sites (defined as “other” in Table 2 ) included the following: coronary arteries, subclavian vein, dermal and placental blood vessels, and superficial blood vessels of lower extremities. TEs were mainly venous ( n = 44, 80%), but in two cases, concurrent arterial and venous thrombosis were described [ 19 , 20 ]. Thrombosis was most commonly limited to only one site ( n = 43, 78.18%).…”