Ulcerative colitis presenting with bilateral thalamic infarcts due to cerebral sinus thrombosis.

A 35-year-old woman with ulcerative colitis was transferred to our hospital because of 2-day history of altered mental status and headache. Apparently, 2 weeks prior to the transfer she had been having increased nausea, vomiting, and diarrhea. She was diagnosed and reported with extensive thrombosis of the intracranial venous system. There was thrombosis of internal cerebral veins, the superior sagittal sinus, straight sinus, and transverse and sigmoid sinuses with extension into jugular veins. There was also acute ischemia of thalami bilaterally. Homocysteine and protein C levels were normal. Protein S and thrombin levels were slightly low. Subsequently, Figure 1. (A) Sagittal MR venogram showing absence of flow through the superior sagittal sinus (white arrow) and confluence of sinuses (black arrow). (B) Coronal imaging demonstrates absence of flow in superior sagittal sinus (black arrow) and transverse sinus (white arrow). anticoagulation was initiated with continuous intravenous infusion of heparin.