|Home | About | Journals | Submit | Contact Us | Français|
A 3-year-old boy with ulcerative colitis and developmental delay presented with a 3-week history of headaches, emesis, and dehydration. His neurologic examination was nonfocal, but MR venogram revealed cerebral sinovenous thrombosis (figure). He was rehydrated and discharged on enoxaparin. Three months later he starting having difficulty reaching for objects and was running into walls. Repeat MRI and MR venogram demonstrated residual thrombosis and interval development of papilledema (figure). Papilledema was confirmed on funduscopic examination. CSF opening pressure was 37 cm H2O. When treatment with acetazolamide failed to control intracranial hypertension, he received a ventriculoperitoneal shunt.
Inflammatory bowel disease (IBD) is a risk factor for venous thromboembolism.1 Attempts to identify a unifying genetic risk factor for thromboembolism in patients with IBD have yielded conflicting results. Endothelial damage from IBD, leading to platelet activation and release of inflammatory mediators by platelets, may play a role.2 Our patient’s prothrombotic workup demonstrated only heterozygosity for both the methylene tetrahydrofolate reductase (MTHFR) C677T and plasminogen activator inhibitor (PAI)-1 4G (also known as SERPINE 1) mutations.
The authors thank Dr. Michelle Nwosu for technical assistance.
Address correspondence and reprint requests to Dr. Meredith Golomb, Indiana University School of Medicine, 575 West Dr. XE-040, Indianapolis, IN 46202 ude.iupui@bmologm
Dr. Golomb is supported by the following grants: NIH NINDS K23 NS 048024 and Clarian Values Fund grant VFR-171.
Disclosure: The authors report no disclosures.