Unraveling the Clinical Puzzle of Cerebral Venous Sinus Thrombosis in Ulcerative Colitis: Insights from a Systematic Review
Ahmed Negida1, Sadeen Eid2, Hamza Alsalhi3, Mohammed Alhallaq4, Zeid Qudeimat2, Muhammad Idrees5, Yusra Arafeh2, Sirajeddin Belkhair6
1Neurology, Virginia Commonwealth University, 2Jordan University of Science and Technology, 3Hashemite University, 4Mansoura University, 5Lahore General Hospital, 6Hamad Medical Corporation
Objective:
This research aims to identify the clinical characteristics, diagnosis, and management of CVST in UC patients to bridge the literature gap.
Background:

Ulcerative colitis (UC) is a long-standing inflammatory bowel disease (IBD) predominantly affecting the colon. UC patients commonly develop extraintestinal manifestations, one of which is venous thromboembolism, which can reach the cerebral venous sinuses and result in cerebral vascular thrombosis (CVT). CVT is potentially life-threatening and may manifest as headaches, seizures, or other neurological symptoms.

Design/Methods:
We searched Medline/PubMed, Scopus, Cochrane, Science Direct, Google Scholar, ClinicalTrials.gov, and Web of Science databases from their inception until February 2024 for papers reporting cerebral venous sinus thrombosis (CVST) in UC patients. We excluded studies evident to have a non-UC cause, results from mixed etiologies, review articles, RCTs, gray literature, and papers not written in English.
Results:

Of 1156 studies, 39 were included for analysis, comprising 47 patients aged 2-60 years, with the majority being adult males (33.3%). Patients commonly presented with a headache (67.4%) and for analysis were divided based on the number of presenting symptoms. Subgroup analysis showed that the multi-symptom group commonly presented in adults (66%; p=0.038) and usually observed during a flare-up of UC (56.4%). They also more likely involved the straight and sphenoid sinus compared to the single-symptom group (P < 0.001). Results indicated a poorer clinical status among anemic groups (p=0. 009). We observed that CT imaging was the most frequently used initial modality, whereas MRI was the most sensitive. Low molecular weight heparin was effective in modifying prognosis along with warfarin, and endovascular thrombectomy.

Conclusions:
CVST in UC patients is characterized by composite symptoms, most commonly headaches. Patients experiencing anemia had a poorer prognosis. Reliable diagnosis is possible by MRI, and timely treatment with anticoagulants and thrombectomy contributed to better outcomes.
10.1212/WNL.0000000000210995
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