Cerebral Arterial Thrombosis in Ulcerative Colitis

Thrombosis, mainly venous, is a rare and well-recognized extraintestinal manifestation of inflammatory bowel disease (IBD). We describe a 25-year-old Caucasian man affected by ulcerative colitis and sclerosing cholangitis with an episode of right middle cerebral arterial thrombosis resolved by intraarterial thrombolysis. We perform a brief review of the International Literature. 1. Introduction Thrombosis, mainlyh venous, is a rare and well-recognized extraintestinal manifestation of inflammatory bowel disease (IBD). Arterial Thromboembolic (TE) complications, and in particular strokes, occur less frequently [1]. They usually have embolic origins [2] and represent an important cause of morbidity and mortality. The management of these conditions need a multidisciplinary therapeutic approach and requires awareness for prevention [2]. Here we describe a stroke case due to arterial thrombosis in a patient with ulcerative colitis. 2. Case Report A 25-year-old Caucasian man was observed in the emergency room for a sudden left-sided hemiparesis characterized by sensitive impairment, confusion and bladder incontinence. NIH stroke scale score (NIHSS) impairment was 8. A diagnosis of ulcerative colitis (UC) and sclerosing cholangitis (SC) had been made 8 years before. He also referred an episode of acute pancreatitis 7 years before as a complication of mesalazine therapy. He had no familial history of cerebral vascular disease (CVD). At clinical examination the patient was normotensive and without fever. Blood tests showed iron deficiency anemia (Hb 7.7？g/dL normal value 13–18), raised white cell counts (WBC 12.470/mmc-n.v. 4000–11000/mmc), erythrocytes sedimentation (ERS) 56 (n.v. < 10), reactive C protein 7.6？mg/L, (n.v.—until 5？mg/dL), gamma Glutamil trans-peptidase (297？U/L-n.v. 11–49), gamma globulin 2.55？g/dL, (n.v. until 1.8？g/dL) antinuclear antibodies 1？:？640 (v.n. negative). An emergency brain angio-computed tomography (A-CT) evidenced thrombosis of the M2 tract of the right middle cerebral artery, without any (apparent) other brain lesions (Figure 1). After an A-CT, an angiographic study was immediately performed, which confirmed thrombosis of the right middle artery, and a local intraarterial thrombolysis by urokinase (actylise 20？mg) was successfully performed (Figures 2(a) and 2(b)). The procedure was complicated by mental alteration with agitation and required a brief observation in an intensive treatment ward recovering within 24 hours (NIHSS 2). The postprocedural brain CT was normal. A following brain nuclear magnetic resonance (NMR) revealed an