Cerebral Vein Sinus Thrombosis, An Unusual Complication of Inflammatory Bowel Disease

Abstract

Cerebral venous sinus thrombosis (CVST) is a rare but severe complication of inflammatory bowel disease (IBD). We present 4 cases (3 cases of ulcerative colitis, 1 of Crohn's disease) with CVST over a 10-year period (2014-2024). Symptoms included confusion, headache, seizures, and focal deficits, often initially misdiagnosed. Diagnosis required computed tomography/magnetic resonance venography. Therapeutic anticoagulation and IBD control (steroids, biologics, or surgery) led to favourable outcomes in 3 cases. One patient required thrombectomy. Thrombophilia screening revealed protein C deficiency and JAK2 mutation in 2 cases. This series highlights CVST as a critical consideration in IBD patients with neurological symptoms. Physicians should pay attention in patients who have pre-existing risk factors and in acute flare of IBD are susceptible to this unusual complication, and advocate for prompt imaging and anticoagulation. LEARNING POINTS: Isolated cerebral venous sinus thrombosis (CVST) without deep venous thrombosis or pulmonary embolism is rare in inflammatory bowel disease (IBD).Clinical presentation is often vague, even unenhanced computed tomography scan can miss CVST, acute care physicians should be aware of this complication of IBD.Why certain patients develop isolated CVST calls for future research.Prompt anticoagulation is the key in management of CVST.