Cerebrovascular Thrombosis in Pediatric Ulcerative Colitis: A Case Report

Abstract

Background and Clinical Significance: Venous thromboembolism (VTE) is a severe extra-intestinal manifestation that can complicate the course of inflammatory bowel disease (IBD). Among pediatric patients, cerebral thrombosis (CT) is the most common form of VTE associated with IBD. Magnetic resonance imaging (MRI) remains the gold standard for diagnosing cerebral venous thrombosis, allowing visualization of flow absence and intraluminal thrombus. Prompt initiation of treatment with low-molecular-weight heparin (LMWH) is crucial to prevent complications. Follow-up imaging is essential to evaluate venous recanalization and guide therapy duration. However, data on cerebral thrombosis in pediatric patient with IBD remain scarce. Case Presentation: We report the case of a 12-year-old boy with a known history of ulcerative colitis who presented to the emergency room (ER) with a two-day history of headache and vomiting. One month prior to the ER visit, he experienced an IBD flare confirmed through clinical, biochemical, and endoscopic evaluation and was subsequently started on oral corticosteroids. Neurological examination was unremarkable; however, given the persistence of severe headache, a brain MRI was performed, leading to a diagnosis of cerebral venous thrombosis. Anticoagulation therapy with LMWH was initiated immediately. Follow-up imaging with contrast-enhanced MR venography four months later revealed partial resolution of the thrombosis. The patient continued long-term anticoagulation therapy for a total duration of 12 months. Conclusions: Cerebral venous thrombosis is a serious complication of IBD, particularly in pediatric patients. Clinicians should consider this diagnosis in any child with IBD presenting with persistent headache, even in the absence of focal neurological signs. Early diagnosis and prompt anticoagulation therapy are key to improving outcomes in these patients.

Keywords: children; inflammatory bowel disease; thrombosis.

Figure 1

Contrast-enhanced MR venography: the red arrow shows an extensive sinus thrombosis involving the right transverse sinus.

Figure 2

(a) Follow-up contrast-enhanced MR venography at month 4. The red arrow shows partial resolution of thrombosis in the right transverse sinus. (b) Follow-up contrast-enhanced MR venography at month 12 demonstrates complete resolution of the thrombosis.