Cerebral sinus thrombosis has been reported as an uncommon complication of ulcerative colitis (UC), occurring in up to 7.5% of cases. It is suspected to be a consequence of genetic predisposition and the hypercoagulable state occurring during disease relapse. We report a case of a 23-year-old male patient with one-year history of UC. He presented to the Emergency Room with left-sided progressive hemiparesis, numbness, hemiparesthesia, and pain, which followed a recent exacerbation of UC. The patient died 3 days after admission and an autopsy revealed superior and inferior sagittal sinus and cortical vein thrombosis with associated cerebral edema, hemorrhagic infarction, and herniation. The gastrointestinal tract had continuous cobblestone appearance extending from rectum to cecum, with hemorrhage and ulceration, consistent with active UC. Awareness of this rare complication of UC can contribute to early recognition and attempts at treatment of this serious and often fatal condition. 1. Introduction Inflammatory bowel disease (IBD) comprises two major entities: ulcerative colitis (UC) and Crohn disease (CD). Ulcerative colitis is an idiopathic chronic IBD that is a consequence of complex interaction of environmental factors and genetic susceptibility [1]. It often occurs in patients between the ages of 20 and 30 years, with a second peak between the ages of 70 and 80 years. UC can be regarded as a systemic disease, and extraintestinal complications have been described in the skin, joints, bones, lungs, blood, eyes, kidneys, liver, and peripheral and central nervous system. CNS manifestations are particularly severe: they include thrombotic and cerebrovascular disease, myelopathy, cerebral vasculitis, multiple sclerosis, and acute disseminated encephalomyelitis [2]. Patients with IBD can also develop a hypercoagulable state and have been noticed to have an increased risk of various thrombotic events. These patients tend to suffer thrombosis earlier in life than patients without IBD [3]. Deep venous thrombosis and pulmonary thromboembolism are the two most common thrombotic complications of UC [4]. Cerebral vein and sinus thrombosis (CVST) has been reported as an uncommon but severe complication of UC and CD, ranging in frequency from 1.3% up to 7.5% of cases yearly depending on the clinical study [5]. The exact pathogenesis of this complication remains unknown and has been largely attributed to a hypercoagulable state that can occur in these patients. The thrombosis occurs more frequently during disease relapse but has also been reported 10 years after
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