Chronic inflammatory bowel disease and cerebrovascular insults in a pediatric patient: a case report

Introduction: Patients with chronic inflammatory bowel disease are at increased risk for stroke or thrombosis. Hypovolemia, thrombocytosis, ongoing inflammation as well as an increased endogenous production of thrombin all contribute to the formation of thrombus. Nevertheless the exact pathogenesis of this thrombosis risk has not yet been elucidated.

Case report: A four year old boy presented with anemia (HB 4mg/dl) and bloody diarrhoe. Colonoscopy revealed acute inflammatory mucosa. During this episode the patient developed transient hemi paresis on the left side followed by transient multiple cranial nerve palsies as well as swallowing problems. MRI and MRI angiography showed acute thrombosis of the sagittal sinus vein The boy recovered completely under immunsuppressive therapy. Four years later the boy experienced another aggravation of his inflammatory bowel disease. Laparatomy was done because of suspicion of intestinal perforation and a colostoma was placed. Twelve hours after laparatomy he again had a hemi paresis on the right side. At this time CT scan and MRI show an ischemic stroke with occlusion of his left medial cerebral artery.

Conclusion: Cerebrovascular complication are well known comorbidities in patients with chronic inflammatory bowel disease and are especially observed in phases of aggravation of the inflammatory disease The neurologic signs are often transient. For these patients thromboembolic prophylaxis and optimal hydration is highly recommended.