Cerebral Venous Thrombosis as a Manifestation of Acute Ulcerative Colitis

Ulcerative colitis is associated with a number of extraintestinal complications, in cluding the infrequent occurrence of throm boembolic disease. Cerebral venous thrombosis is extremely rare, with only 15 cases reported in the literature. The outcome in this group of patients is poor; the resuit in more than 80% of the cases is permanent neurologie sequelae or death. The precise mechanisms involved in thrombogenesis remain unclear. A hypercoagu lable state may occur in ulcerative colitis because of welldocumented associations of thrombocy tosis, elevated factors V and VUE and fibrinogen, and decreased antithrombin III. Treatment reg imens for cerebral venous thrombosis remain controversial and include anticoagulation with heparin, surgical thrombectomy, and systemic and local infusion of fibrinolytic regimens. A conservative approach with antiedemic agents, anticonvulsants, antiplatelet therapy, and acet azolamide also may be beneficiai and offers a substantially reduced hemorrhagic potential. A case of primary superior sagittal sinus thrombosis associated with active ulcerative colitis treated by the latter method is reported. The pa tient's neurologie recovery was complete, with recanalization of the thrombosed venous sinus being demonstrated by magnetic resonance imaging studies