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A case of cerebral venous sinus thrombosis associated with Crohn's disease: dilemma in management.

Kwon Y, Koene RJ, Cho Y - Gastroenterol Rep (Oxf) (2014)

Bottom Line: Timely diagnosis, particularly in younger patients, requires a high level of suspicion in order to prevent potentially devastating complications such as hemorrhage or venous infarction.Achieving therapeutic anticoagulation with warfarin was difficult, due to presumed pharmacological interaction between warfarin and 6-mercaptopurine.Clinicians should have a high index of suspicion for CVST when a patient with Crohn's disease presents with acute headache, and be aware of challenges related to medical management.

View Article: PubMed Central - PubMed

Affiliation: St. Joseph's Hospital, HealthEast Care System, Saint Paul, Minnesota, USA and Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA kwonx208@umn.edu.

No MeSH data available.


Related in: MedlinePlus

Computed tomography of the head on admission, showing hyperdensity within the superior sagittal sinus (A) and the left transverse sinus (B).
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gou079-F1: Computed tomography of the head on admission, showing hyperdensity within the superior sagittal sinus (A) and the left transverse sinus (B).

Mentions: A 44-year-old Caucasian woman with a history of Crohn's disease and deep vein thrombosis (DVT) was admitted to our hospital with a five-day history of a severe, throbbing and generalized headache. She had associated nausea, vomiting and photophobia. Her Crohn's disease history was notable for multiple bowel resections, including one within the past month. Home medications included 100 mg of 6-mercaptopurine (6-MP) once daily for Crohn's disease and an estradiol patch for menopausal symptoms. The latter was discontinued upon admission. Neurological examination showed mild meningismus upon neck flexion, with no other focal abnormalities. Computerized tomography (CT) of the head demonstrated a hyperdensity within the superior sagittal and left transverse sinuses, without parenchymal changes, suggesting dural sinus thrombosis (Figure 1). Subsequent magnetic resonance imaging with venography (MRI-MRV) confirmed an intraluminal thrombosis involving the sagittal, transverse, and sigmoid sinuses, and extending into the cranial portion of the internal jugular vein (Figure 2). Other abnormalities included an elevated platelet count of 501 x 109/L and an increased C-reactive protein of 9.1 mg/L. Hypercoagulability assays showed heterozygosity for factor V Leiden (FVL) but no mutations in the prothrombin (G20210A) and methylenetetrahydrofolate reductase (C677T) genes. Thrombophilic profiling including protein C, S, antithrombin III activity, homocysteine and antiphospholipid antibodies was normal.Figure 1.


A case of cerebral venous sinus thrombosis associated with Crohn's disease: dilemma in management.

Kwon Y, Koene RJ, Cho Y - Gastroenterol Rep (Oxf) (2014)

Computed tomography of the head on admission, showing hyperdensity within the superior sagittal sinus (A) and the left transverse sinus (B).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4863183&req=5

gou079-F1: Computed tomography of the head on admission, showing hyperdensity within the superior sagittal sinus (A) and the left transverse sinus (B).
Mentions: A 44-year-old Caucasian woman with a history of Crohn's disease and deep vein thrombosis (DVT) was admitted to our hospital with a five-day history of a severe, throbbing and generalized headache. She had associated nausea, vomiting and photophobia. Her Crohn's disease history was notable for multiple bowel resections, including one within the past month. Home medications included 100 mg of 6-mercaptopurine (6-MP) once daily for Crohn's disease and an estradiol patch for menopausal symptoms. The latter was discontinued upon admission. Neurological examination showed mild meningismus upon neck flexion, with no other focal abnormalities. Computerized tomography (CT) of the head demonstrated a hyperdensity within the superior sagittal and left transverse sinuses, without parenchymal changes, suggesting dural sinus thrombosis (Figure 1). Subsequent magnetic resonance imaging with venography (MRI-MRV) confirmed an intraluminal thrombosis involving the sagittal, transverse, and sigmoid sinuses, and extending into the cranial portion of the internal jugular vein (Figure 2). Other abnormalities included an elevated platelet count of 501 x 109/L and an increased C-reactive protein of 9.1 mg/L. Hypercoagulability assays showed heterozygosity for factor V Leiden (FVL) but no mutations in the prothrombin (G20210A) and methylenetetrahydrofolate reductase (C677T) genes. Thrombophilic profiling including protein C, S, antithrombin III activity, homocysteine and antiphospholipid antibodies was normal.Figure 1.

Bottom Line: Timely diagnosis, particularly in younger patients, requires a high level of suspicion in order to prevent potentially devastating complications such as hemorrhage or venous infarction.Achieving therapeutic anticoagulation with warfarin was difficult, due to presumed pharmacological interaction between warfarin and 6-mercaptopurine.Clinicians should have a high index of suspicion for CVST when a patient with Crohn's disease presents with acute headache, and be aware of challenges related to medical management.

View Article: PubMed Central - PubMed

Affiliation: St. Joseph's Hospital, HealthEast Care System, Saint Paul, Minnesota, USA and Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA kwonx208@umn.edu.

No MeSH data available.


Related in: MedlinePlus