CEREBRAL VENOUS THROMBOSIS DURING PREGNANCY IN PARTURIENT WITH CHRONIC INFLAMMATORY BOWEL DISEASE: CASE REPORT AND REVIEW OF THE LITERATURE

Introduction: Pregnancy and post partum represent major risk factors for Cerebral venous thrombosis (CVT) and this last is exceptional in inflammatory bowel disease. We report the case of a parturient with ulcerative colitis who presented a CVT in the immediate postpartum. We want through this case, and a review of the literature, to expose an atypical clinical presentation of CVT appearing in the postpartum. Observation: 20 years old women, followed for ulcerative colitis, received in the immidiate postpartum, antibiotic therapy for endometritis. Then transferred to intensive care for further management, with a stable haemodynamic state, aphasic, behavior trouble, SOFA score at 2. She was maintained on antibiotic and put on antidepressant for a diagnosed depression. Later, the patient presented a generalized tonic-clonic seizure and right hemiparesis. A cerebral CT scan was performed showing thrombophlebitis of the upper longitudinal sinus. Low molecular weight heparin anticoagulation curative dose and anti seizure drugs have been started. The evolution was favorable. Discussion: Approximately 2-20% of pregnancy-related strokes are due to CVT. Several studies have suggested a correlation between thromboembolic events and IBD with a relative risk of 3.6 and an annual incidence of 0.5 to 6.7. In the literature, the diagnosis of CVT is mainly based on clinical suspicion and radiological confirmation. The pregnenecy doesn't modifie the clinical manifestations of CVT. The median delay between the first symptom and the diagnosis is 7 days. The diagnosis of CVT can be confused with other diagnoses and delay management. Otherwise mental status disorders, especially somnolence are more common in obstetric CVT. Cerebral CT scan is the first examination to be performed in front of a suspicion of CVT. Anticoagulation is currently the main treatment The prognosis is variable, ranging from complete recovery to death. Depending on the timing of diagnosis and thus the treatment. Conclusion: Cerebral thrombophlebitis during pregnancy is infrequent, and generally of good prognosis except when the diagnosis is delayed because of atypical manifestations especially neuropsychiatric. Otherwise pregnant women with chronic inflammatory bowel disease should be more rigorously monitored for the occurrence of a thromboembolic events in general, and for cerebral events in particular.