Stroke in inflammatory bowel disease: a report of two cases and review of the literature

Abstract

Thrombosis is a recognised complication of inflammatory bowel disease (IBD), in particular venous thrombosis. Arterial thrombosis, especially stroke is rare. There is a paucity of information regarding stroke in IBD and its management. The authors describe two cases of stroke in patients with IBD during periods of increased disease activity. The literature regarding this devastating complication and the procoagulant state that exists in IBD are reviewed.

Multiple sclerosis and inflammatory bowel diseases: what we know and what we would need to know!

“…29,30 It has been previously emphasized that a number of other disorders need to be excluded as a cause of WML including migraine, small vessel disease and vasculitis. 2,3,20,31 In these disorders "typical" imaging characteristics of MS, such as periventricular lesions and Dawson fingers, posterior fossa lesions, and black holes, are expected to be scarce or absent.…”

Cerebral Arterial Thrombosis in Ulcerative Colitis

“…The cerebral vascular involvement seems more frequent among younger IBD patients, as reported by Houissa et al, that describes that arterial thrombosis is in 4 patients, 3 of them younger than 25 years [3]. Arterial thrombosis, in particular stroke, may be considered a rare condition [4] (Table 1). Cerebral infarction may be associated to a hypercoagulability condition due to various factors, as qualitative and quantitative abnormalities of platelets, and coagulation factors alterations, as elevation of Factor V, Factor VIII and fibrinogen, deficiency of antithrombin III, and antiphospholipid antibody syndrome [14].…”

“…Often these complications present serious and potentially life-threatening conditions. An increased risk is more evident in patients with active ulcerative colitis and, particularly, in those with ulcerative pancolitis [4]. Even if active disease is associated with an increased risk, some cases have been described during the remission periods [3].…”

“…Also dehydration, immobility, sepsis, surgery, and corticosteroid therapy determine cerebral thrombosis in IBD patients [14]. The neurological presentation of cerebral arterial thrombosis may be extremely variable, as headache (95%), uni- or bilateral paresis (43%), general or focal seizures (47%) or dysphasia (37%) [3, 4]. The sequel of cerebral vascular thrombosis can be devastating especially in young patients with active and complicated IBD, determining high mortality and disability in about 60% of cases [3].…”

“…Conventional computed tomography (CT) or magnetic resonance imaging (RMI) identifies the exact site of cerebral affected areas. At this moment, no guidelines are available for the treatment of cerebral thrombosis and stroke in IBD [4]. Low molecular weight heparin is the most common drug used for the prophylaxis and treatment of vascular thromboembolism [15].…”