A 16-year-old girl developed a proximal occlusion of the right middle cerebral artery during a flare-up of acute ulcerative colitis. Although mechanical thrombectomy led to successful middle cerebral artery recanalisation, she required an immediate second thrombectomy due to reocclusion of the same arterial segment. She developed a second ischaemic event 7 days later despite intravenous heparin infusion, later switched to low-molecular-weight heparin, and a third event after 3 days despite the addition of aspirin. We discuss stroke risks in people with inflammatory bowel disease and the uncertainties around anticoagulation and antiplatelet regimens in such cases.
- cerebrovascular disease
- cerebral blood flow
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Twitter @neil_rane, @Dheeraj_Kall
Collaborators On behalf of the Imperial Stroke Research Consortium.
Contributors SYL wrote the manuscript and conducted the literature review. MS contributed to the manuscript. NR was the treating interventional neuroradiogist, provided images for the figures and critically reviewed the manuscript. DK and SB were the treating stroke neurologists and critically reviewed the manuscript. All the authors contributed to the intellectual context and approved the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned. Externally peer reviewed by Rose Bosnell, Bristol, UK.