Carmona M A, Jaume Anselmi F, Ramírez Rivera J
Department of Medicine, Hospital de La Concepción, San Germán, P.R. 00683.
Bol Asoc Med P R. 2000 Jan-Mar;92(1-3):9-11.
Cerebral thrombotic disease is a rare and nearly always fatal complication of ulcerative colitis. It is associated with a necrotizing vasculitis. We report a fatal case with a confusing neurologic picture arising from this complication. Autopsy revealed necrosis and hemorrhages affecting both cortical grey and white matter. Microscopic examination showed thrombosis of small and medium size vessels associated with hemorrhages and a necrotizing angiitis. Ulcerations, hemorrhages, pseudopolyps, and cryptic abscesses were found in the rectosigmoid region of the colon compatible with active ulcerative colitis. A sudden neurologic deficit in a patient with ulcerative colitis should direct attention to the consideration of a cerebral thrombotic event and the possibility of an associated cerebral vasculitis. Diagnosis may be strongly suggested by MRI or arteriography, but it may require confirmation by biopsy of the brain parenchyma and leptomeninges. A hypercoagulable state has been associated with the thrombosis. Anticoagulation has yielded successful results in some patients with cerebral thrombosis but the risk of massive intracranial and gastrointestinal bleeding preclude to establish clear indications. Neurologic improvement has been obtained with the use of steroids and cyclophosphamide.
脑血栓形成疾病是溃疡性结肠炎一种罕见且几乎总是致命的并发症。它与坏死性血管炎相关。我们报告一例因该并发症导致神经系统表现复杂的致命病例。尸检显示皮质灰质和白质均有坏死和出血。显微镜检查显示中小血管血栓形成，伴有出血和坏死性血管炎。在结肠直肠乙状结肠区域发现溃疡、出血、假息肉和隐窝脓肿，符合活动性溃疡性结肠炎表现。溃疡性结肠炎患者突然出现神经功能缺损应引起注意，考虑脑血栓形成事件及相关脑血管炎的可能性。MRI或动脉造影可能强烈提示诊断，但可能需要通过脑实质和软脑膜活检来证实。高凝状态与血栓形成有关。抗凝治疗在一些脑血栓形成患者中取得了成功，但颅内大出血和胃肠道出血的风险使得难以确定明确的适应证。使用类固醇和环磷酰胺已使神经功能得到改善。
