Cerebral Venous Thrombosis in Inflammatory Bowel Diseases: Eight Cases and Literature Review

Abstract

Background While the association between inflammatory bowel diseases and thromboembolic events has long been evident, cerebral venous thrombosis in this context remains rare and underreported. Methods Among 351 consecutive patients with cerebral venous thrombosis collected in two neurology departments between 1997 and 2009, an analysis of patients with inflammatory bowel disease and a review of literature were performed. Results Eight patients had inflammatory bowel disease (6/287, 2/64), Crohn's disease in two, and ulcerative colitis in two. The mean age was 30·9 years (18–45). All inflammatory bowel disease-related cerebral venous thrombosis patients had headache, four patients had focal neurological deficits, three had altered consciousness, and two had seizures. Cerebral venous thrombosis occurred between two-months and 17 years after the first inflammatory bowel disease signs. Six patients had other venous prothrombotic risk factors. All patients were treated with heparin or low-molecular-weight heparin. Seven showed a complete recovery (Rankin 0–1) and one a partial recovery (Rankin 2). Compared with the 49 magnetic resonance imaging-confirmed cerebral venous thrombosis patients of the literature, our patients had more frequent associated prothrombotic risk factors. When comparing 57 inflammatory bowel disease-related cerebral venous thrombosis patients with other cerebral venous thrombosis, those with inflammatory bowel disease were younger in age at cerebral venous thrombosis onset, and there was a higher male to female ratio and a lower headache frequency at presentation. Conclusion In our cerebral venous thrombosis cohort, inflammatory bowel disease is present in 2·3% of cases. As cerebral venous thrombosis has no specific feature and may reveal inflammatory bowel disease, intestinal signs should be systematically looked for. All physicians caring for inflammatory bowel disease patients must consider cerebral venous thrombosis in cases of unusual headache or focal neurological symptoms. Treatment is based on full anticoagulation and specific inflammatory bowel disease treatment.