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Digestive Diseases and Sciences

, Volume 40, Issue 6, pp 1395–1399 | Cite as

Severe thrombotic complications in a postpartum patient with active crohn's disease resulting in ischemic spinal cord injury

  • Warner Bruins Slot
  • Viviane van Kasteel
  • Emile G. Coerkamp
  • P. J. Seelen
  • Sjoerd D. J. van der Werf
Case Report

Summary

This report describes a 33-year-old female patient who presented with severe neurological symptoms and signs during postpartum relapse of Crohn's ileocolitis. The cause of the neurological deficit was extensive major vessel thrombosis resulting in spinal cord ischemia. Etiologic factors involved in this exceptional thrombotic state are discussed with emphasis on the relationship between low levels of folic acid, homocysteine metabolism, and coagulation.

Key words

thrombosis Crohn's disease spinal cord ischemia 

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References

  1. 1.
    Sleisenger MH, Fordtran JS:In Gastrointestinal Disease, Pathophysiology, Diagnosis and Management, 5th ed. MH Sleisenger, JS Fordtran (eds). Philadelphia, PA, W.B. Saunders, 1993, pp 1279–1280Google Scholar
  2. 2.
    Talbot RW, Heppell J, Dozois RR, Beart RW: Vascular complications of inflammatory bowel disease. Mayo Clin Proc 61:140–145, 1986PubMedGoogle Scholar
  3. 3.
    Conlan MG, Hire WD, Burnett DA: Prothrombotic abnormalities in inflammatory bowel disease. Dig Dis Sci 34:1089–1093, 1989PubMedGoogle Scholar
  4. 4.
    More L, Sim R, Hudson M, Dhillon AP, Pounder R, Wakefield AJ: Immunohistochemical study of tissue factor expression in normal intestine and idiopathic inflammatory bowel disease. J Clin Pathol 46:703–708, 1993PubMedGoogle Scholar
  5. 5.
    Edwards RL, Levine JB, Green R, Duffy M, Mathews E, Brande W, Rickles FR: Activation of blood coagulation in Crohn's disease; increased plasma fibrinopeptide A levels and enhanced generation of monocyte tissue factor activity. Gastroenterology 92:329–337, 1987PubMedGoogle Scholar
  6. 6.
    Rees MM, Rodgers GM: Homocysteinemia: Association of a metabolic disorder with vascular disease and thrombosis. Thrombos Res 71:337–359, 1993Google Scholar
  7. 7.
    Colman RW, Hirsh J, Marder VJ, Salzman EW:In Hemostasis and Thrombosis, Basic Principles and Clinical Practice, 2nd ed. RW Colman, J Hirsh, VJ Marder, EW Salzman (eds). Philadelphia, PA, J.B. Lippincott, 1987, pp 1189–1192Google Scholar
  8. 8.
    Wakefield AJ, Sawyerr AM, Hudson M, Dhillon AP, Pounder RE: Smoking, the oral contraceptive pill, and Crohn's disease. Dig Dis Sci 36:1147–1150, 1991PubMedGoogle Scholar
  9. 9.
    Kang SS, Wong PWK, Norusis M: Homocysteinemia due to folate deficiency. Metabolism 36:458–462, 1988Google Scholar
  10. 10.
    Stabler SP, Marcell PD, Podell ER, Allen RH, Savage DG. Lindenbaum J: Elevation of total homocysteine in the serum of patients with cobalamin or folate deficiency detected by capillary gas chromatography-mass spectometry. J Clin Invest 81:466–474, 1988PubMedGoogle Scholar
  11. 11.
    Brattström L, Israelsson B, Lindgärde F, Hultberg B: Higher total plasma Homocysteine in vitamin B12 deficiency than in heterozygosity for homocysteinuria due to cystathionine beta-synthase deficiency. Metabolism 37:175–178, 1988PubMedGoogle Scholar
  12. 12.
    Mudd SH, Levy HL, Skovby F: Disorders of transulfuration.In C Scriver, AL Beaudet, WS Sly, D Balle (eds.). The Metabolic Basis of Inherited Disease. 1989, pp 693–734Google Scholar
  13. 13.
    Mudd SH, Skovby F, Levy HL, et al: The natural history of homocysteinuria due to cystathionine beta-synthetase deficiency. Am J Hum Genet 37:1–31, 1985PubMedGoogle Scholar
  14. 14.
    Wilcken DEL, Dudman NPB: Mechanisms of thrombogenesis and accelerated atherogenesis in homocysteinemia. Haemostasis 1(suppl):14–23, 1989Google Scholar
  15. 15.
    Rodgers GM, Conn MT: Homocysteine, an atherogenic stimulus, reduces protein C activation by arterial and venous endothelial cells. Blood 75:895–901, 1990PubMedGoogle Scholar
  16. 16.
    Rodgers GM, Kane WH: Activation of endogenous factor V by homocysteine-induced vascular endothelial cell activator. J Clin Invest 77:1909–1916, 1986PubMedGoogle Scholar
  17. 17.
    Fernandez-Banares F, Abad-Lacruz A, Xiol X, Gine JJ, Dolz C, Cabre E, Esteve M, Gonzalez-Huix F, Gassull MA: Vitamin status in patients with inflammatory bowel disease. Am J Gastroenterol 84:744–748, 1989PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Warner Bruins Slot
    • 1
  • Viviane van Kasteel
    • 1
  • Emile G. Coerkamp
    • 1
  • P. J. Seelen
    • 1
  • Sjoerd D. J. van der Werf
    • 1
  1. 1.From the Departments of Medicine, Neurology, and Diagnostic Radiology and Westeinde LaboratoriesWesteinde HospitalThe HagueThe Netherlands

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