Unraveling the Clinical Puzzle of Cerebral Venous Sinus Thrombosis in Ulcerative Colitis: Insights from a Systematic Review

Abstract Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that primarily affects the colon. Among its extraintestinal complications, cerebral venous sinus thrombosis (CVST) is a rare yet potentially life-threatening emergency that can manifest as headaches, seizures, and/or neurological deficits. This review aims to characterize the clinical presentation, diagnostic modalities, and management strategies for CVST in UC patients. A comprehensive search of case reports and series yielded 1,156 studies, of which 39 met the inclusion criteria. A total of 47 patients were identified; the majority of whom were adult males (33.3%) and commonly presented with headaches (67.4%). Multi-symptom presentations were more prevalent in adults (66%; p = 0.038) and were often associated with UC flare-ups (56.4%). Patients with multiple symptoms had a higher frequency of straight and sphenoid sinus involvement compared with those with an isolated symptom (p < 0.001). Anemia was correlated with poorer clinical outcomes (p = 0.009). Computed tomography (CT) was the most frequently used initial imaging modality, whereas magnetic resonance imaging (MRI) was more sensitive. Anticoagulation therapy with low-molecular-weight heparin and warfarin, alongside endovascular thrombectomy in select cases, was effective in improving outcomes. This review underscores the importance of early recognition, MRI-based imaging, and timely anticoagulation to improve outcomes in UC-associated CVST.