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 extra-intestinal manifestations and can present with thrombotic events in young patients with iron deficiency and hyperhomocysteinemia.

Case Report: Cerebral venous thrombosis revealing celiac disease

“…11 Seizures are nonspecific and can simply be a consequence of cerebral thrombosis. 12,13 In addition, thromboembolic manifestations and cardiovascular disease events represent serious extraintestinal manifestations of CD due to malabsorption (vitamin B12 deficiency, vitamin B6 deficiency, folic acid deficiency, vitamin D deficiency, and carnitine deficiency), chronic inflammation, endothelial dysfunction, thrombocytosis, protein C and S deficiency, thrombophylic autoantibodies and atherosclerosis. 14 So a thrombosis assessment should be considered in patients with CD.…”