Unusual Case of Cerebral Venous Sinus Thrombosis in Patient with Ulcerative Colitis in Remission

Abstract

A 38-year-old female presented to the emergency department of MKCG Medical College and hospital with chief complaints of a two day history of generalized headache associated with nausea, vomiting, blurring of vision and photophobia. This was associated with one episode of generalized tonic-clonic seizure a few hours prior to arrival at the ER. Her previous history was not suggestive of any prior episode of transient ischemic attacks, stroke or seizures. She was diagnosed as a case of Ulcerative Colitis (UC) two years back. She was on oral steroids, 5-Amino Salicylic Acid (5-ASA) and sulfasalazine following which she was symptom-free for last one year.On examination she was afebrile and normotensive. Glasgow Coma Scale (GCS) was 11/15 (E3V4M4) with bilateral plantar extensor. Fundoscopy revealed changes suggestive of early papilloedema in both eyes. Routine tests revealed a normocytic normochromic anaemia with a haemoglobin of 9.8 g%, total leukocyte count of 10,400/mm 3 , Erythrocyte Sedimentation Rate (ESR) of 18mm in 1 st hour, platelet count was 3.01 lakhs/mm 3 . C-Reactive Protein (CRP)was 10.6 mg/dl. Prothrombin Time (PT) was 13.0 seconds (Reference range: 12-13 seconds), International Normalised Ratio (INR) was 1.45, activated partial thromboplastin time (aPTT) was 36 seconds (Reference range: 32-40 seconds). Liver and renal function tests along with serum electrolytes were within normal limits. Sickling test was negative. Blood and stool cultures collected on the day of admission were negative for known pathogens. Stool routine and microscopy revealed few leukocytes and erythrocytes. Rectal examination was negative for melena, bleeding or diarrhoea. Non-Contrast Computerised Tomography (NCCT) scan of the head was normal. Owing to her young age and absence of known risk factors for stroke, cerebral venous sinus thrombosis was suspected and MRI venography was ordered which showed a filling defect in left transverse sinus and left sigmoid sinus [Table/ Fig-1]. A provisional diagnosis of Cerebral Venous Sinus Thrombosis (CVST) was made and she was immediately put on intravenous Low Molecular Weight Heparin (LMWH) therapy and phenytoin.Prothrombotic work-up and coagulation studies were negative for protein C and protein S activity, Antithrombin III activity, Anti-phospholipid antibody, Homocysteine and factor V Leiden

Cerebral Venous Sinus Thrombosis in Patients With Inflammatory Bowel Disease: A Retrospective Study

“…Transverse sinus and superior sagittal sinus were frequently involved. This was in accordance with some previous study [6,8,9] .…”

“…In our study, CVST often occurs during acute IBD, in rare conditions during remission. Case reports also showed the occasionally events during IBD remission [6] . Male accounted for majority (65.4%).…”

“…CVST often occur during disease are. Nevertheless, some case reports did show CVST occurred during disease remission [6] . Better understanding the risk factors and clinical manifestations for CVST may assist with early diagnosis and treatment, thus the prognosis could be improved.…”

Cerebral venous sinus thrombosis in a 19 year old female with ulcerative colitis: long term follow-up and review from the literature

“…Meher at al, 2016 have reported a case of a 38-year-old female with a history of UC in remission who developed sudden onset headache, blurring of vision and seizures 16 . Subsequent diagnosis of cerebral venous sinus thrombosis (transverse and sigmoid sinus) was made with MRI venography and treated with low molecular weight heparin with complete resolution of symptoms.…”

A Case of Cerebral Venous Sinus Thrombosis Presenting During Relapse of Ulcerative Colitis

“…Cerebral venous sinus thrombosis is a well-documented cause of acute onset neurological dys-function in patients with IBD. Cerebral venous sinus thrombosis has been reported in patients with IBD during acute relapse [8].…”