Cerebral venous thrombosis associated with childhood ulcerative colitis

Abstract

Ulcerative colitis UC can be complicated by various extra ndash;intestinal manifestations such as thromboembolic disease Most thrombotic events occure in lower extremities whereas the incidence of cerebral venous involvement is very rare and serious in children We present a case of a nine years old boy with UC and cerebral venous thrombosis diagnosed at the same time A nine years old boy with a 3 week history of bloody diarrhea and abdominal pain was admitted to our hospital On admission his laboratory data showed anemia leukocytosis thrombocytosis and elevated erythrocyte sedimentation rate Colonoscopic evaluation revealed severe active pancolitis with diffuse ulceration The day after colonoscopy he had complained of severe headache Neurolological examination revealed pitosis of the left palpebra and bilateral papilledema Magnetic resonance MR imaging and MR venography revealed thrombosis in the left transvers sinus and sigmoid sinus The patient was treated immediatly with heparin At the same time he was diagnosed with severe active UC based upon histopathological findings and managed initially with mesalamin and prednisolon He also had been screened for thrombophilia Protein C protein S antithrombin III factor VIII homocystein prothrombin II and fibrinogen levels were in the normal range but he was heterozygous for the methylene tetrahydrofolate reductase gene mutation After two weeks of therapy his bloody diarrhea was controlled headache and neurolological findings were improved His treatment was continued with mesalamin prednisolon azathioprin and low molecular weight heparin but repeated MRI and MRI venography showed neither extension nor improvement of the thrombosis Turk Arch Ped 2013; 48: 160 4

Keywords

• Cerebral venous thrombosis, complication, ulcerative colitis

Çocukluk çağı ülseratif kolit hastalığına bağlı beyin ven trombozu

Öz

Beyin ven trombozu çocuklarda enflamatuar bağırsak hastalığının; özellikle ülseratif kolitin seyri sırasında gelişebilen nadir ancak önemli bir komplikasyondur Dokuz yaşında kanlı mukuslu dışkılama ve beraberinde gelişen şiddetli başağrısı yakınması ile gelen ülseratif kolit ile aynı anda beyin ven trombozu tanısı alan bir olgu sunuldu Dokuz yaşında erkek hasta üç haftadır süren kanlı ve mukuslu dışkılama nedeni ile başvurdu Tetkiklerinde anemi lökositoz trombositoz ve yüksek eritrosit çökme hızı saptanan hastanın kolonoskopik incelemesinde yaygın ülserler ile seyreden pankolit görüldü ve tanı histopatolojik inceleme ile ülseratif kolit olarak kesinleştirildi Kolonoskopiden bir gün sonra sürekli zonklar tarzda frontal ve sol oksipital bölgeye yerleşik başağrısı yakınması gelişen hastanın nörolojik değerlendirilmesinde sol göz kapağında pupil seviyesinde pitoz her iki göz dibinde birinci derece papil ödem saptandı Kraniyal manyetik rezonans görüntüleme ve manyetik rezonans venografi incelemesinde sol transvers ve sigmoid sinüsde tromboz saptanan hastaya antikoagülan tedavi ile ülseratif kolit için mesalamin ve steroid başlandı Trombofili açısından da değerlendirilen hastanın protein C protein S antitrombin III faktör VIII homosistein protrombin II and fibrinojen düzeyleri normal sınırlarda; metilen tetrahidrofolat redüktaz gen mutasyonu ise heterozigot pozitif saptandı Tedavinin ikinci haftasında kanlı dışkılaması kontrol altına alınan hastanın başağrısı azaldı papilödem ve pitozu kayboldu Mesalamin prednisolon azatiyopürin ve düşük molekül ağırlıklı heparin ile tedavisi devam ettirilen olgumuzda tedavinin birinci yılında manyetik rezonans venografi incelemesinde trombozda radyolojik açıdan artma yada düzelme izlenmedi.

Anahtar Kelimeler

• Beyin ven trombozu
• komplikasyon
• ülseratif kolit

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