Successful management of dural venous sinus thrombosis secondary to ulcerative colitis in a pediatric patient: A case report

Abstract

Cerebral venous sinus thrombosis secondary to inflammatory bowel disease is a clinically rare and challenging entity with serious sequela. We preset a case of a 15-year-old female patient who was recently diagnosed with ulcerative colitis and had been suffering from headache for 4 days duration. During the diagnostic workup, computed tomography (CT) venography revealed Dural venous sinus thrombosis in the left transverse sinus extending into the left sigmoid sinus and the upper third of the left internal jugular vein as well as into the sinus confluence with non-occlusive filling defects in the superior sagittal sinus. Anticoagulant therapy with enoxaparin was initiated and the patient is being monitored in an outpatient setting regularly. Post-discharge disease course was uneventful. CT venography performed after 3 months illustrated partial recanalization of both left transverse and sigmoid sinuses. CVST is a rare extraintestinal manifestation of ulcerative colitis with significant morbidity and mortality which requires a high level of suspicion to establish a clear diagnosis. In spite the fact that CVST is rare, it should be ruled out in inflammatory bowel disease patients with new onset seizures, headache, along with focal, and non-focal neurologic symptoms.

Keywords: Dural venous sinus thrombosis; Hypercoagulable state; Inflammatory bowel disease; Sinus thrombosis; Ulcerative colitis.

Fig. 1

Coronal non–enhanced CT scan showing hyperdense left transverse and sigmoid sinus marked by the arrow (A). CT venogram coronal view demonstrating absence of contrast filling in the left transverse and sigmoid sinuses (arrow heads); consistent with venous sinus thrombosis (B). CT venogram coronal view after 3 months follow-up demonstrating partial recanalization of the left transverse and sigmoid sinuses as marked by the arrow (C).