Cerebral venous thrombosis in children with inflammatory bowel disease: case reports

Inflammatory bowel disease may be complicated by central and peripheral venous thrombosis, with cerebral vessel involvement representing the most life-threatening localization in childhood. Cerebral venous thrombosis occurs in approximately 3% of children with inflammatory bowel disease and most frequently develops during disease exacerbation. This article presents four cases of cerebral venous thrombosis: three in children with ulcerative colitis and one in a patient with Crohn disease. The first case describes an 8-year-old boy with ulcerative colitis, a history of neonatal cerebral ischemia, and intestinal disease onset at 6 years of age. Chronic relapsing ulcerative colitis was complicated during an acute exacerbation by intestinal bleeding, requiring emergency colectomy with ileostomy. One and a half months after surgery, the patient developed an acute cerebrovascular event (ischemic stroke). To date, the child has persistent spastic hemiparesis. The second case involves a 10-year-old boy with chronic continuous ulcerative colitis refractory to both glucocorticoid and biologic therapy, who died following a cerebral infarction caused by thrombosis of the cerebral arteries. The third case is a very-early-onset inflammatory bowel disease in a 6-year-old girl (ulcerative colitis diagnosed at 2 years of age), who had maintained remission for 3 years on maintenance therapy; during a disease exacerbation, she developed acute thrombosis of the superior sagittal sinus. The fourth case describes a 16-year-old adolescent with Crohn disease complicated by ileal strictures and enteroenteric and pararectal fistulas; sagittal sinus thrombosis developed one week after initiation of glucocorticoid therapy. This life-threatening condition influenced surgical strategy, necessitating an initial diverting stoma rather than immediate radical surgery. Risk factors for cerebral venous thrombosis in our patients included early disease onset, continuous disease course, genetic predisposition, multiple courses of steroid therapy, severe disease activity, and surgical treatment. An individualized approach and tailored treatment strategy allow favorable outcomes to be achieved in most cases. In children with inflammatory bowel disease — especially during severe disease activity and in the presence of thrombotic risk factors — early identification and differentiation of vascular complications are critically important. Patients with cerebral venous thrombosis require follow-up and a multidisciplinary approach with mandatory involvement of neurosurgeons, neurologists, and rehabilitation specialists. Unfortunately, practicing physicians remain insufficiently aware of these complications of inflammatory bowel disease, which contributes to delayed diagnosis and fatal outcomes.