Stroke and IBD: A Report and Review

            This article was a great find because in our last class we ended with the Stroke group and began discussing Irritable Bowel Disease. The article presents two stroke cases in which each patient had been previously diagnosed with a classification of IBD called Ulcerative Colitis. Neither patient had any history or risk factors that would lead to cerebral vascular complications, but both were found to have ischemic infarction after being admitted to the hospital.

            The first patient had hemiparesis, on arrival, meaning that he was able to move but with much limited strength. In the discussion it is first mentioned that "Deep vein thrombosis with or without pulmonary embolism remains the most common vascular event complicating inflammatory bowel disease" and continue to say that the CNS is not usually involved in these thrombotic events. Could it be that the thrombotic event in the enterogastric region can lead to global ischemia in the cerebral region? This would be a good theory, but it doesn't explain how an event so distal would lead to the ischemic and focal infarct seen in the tomography and CT that was taken of both patients. The paper states that "Inflammation during episodes of increased disease activity is a potent prothrombotic stimulus due to fibrinolysis inhibition," so it may have the lack of prevention in clotting blood played a role. It even further explains the pro-inflammatory cytokines that are hyperactive in IBD, but what caught my interest was that "studies have also examined the role played by platelet-leukocyte aggregates (PLA) which are increased in patients with IBD." My last article I had discussed in class failed to analyze the Platelet-Leukocyte aggregation that was seen in the MCAO-R rat group. It's been shown that increased thrombosis risk is recognized in IBD patients and that "PLAs cause microinfarction and exacerbate thrombus formation by enhancing the production of tissue factor." It is possible that these heightened inflammatory activities due to IBD can lead to global or focal ischemic stroke, which has its own increased inflammatory response as well.

            There is little, but growing, awareness of stroke complications in IBD patients. The article provides brief overview of how patients, especially those diagnosed with IBD, should be treated with "aspirin and modification of atherosclerotic risk factors" in order to prevent thrombolytic or embolic events. There is still need for more research in cases such as the ones presented to understand this increased coagulation and the pathology that led these patients to have focal ischemic infarct in the cerebral region. Was IBD actually the cause of their strokes or does it go deeper than that? feel free to comment or add anything on your mind.

Citation

Deepak, Joshi. "Stroke in Inflammatory Bowel Disease: A Report of Two Cases and Review of the Literature." Thrombosis Journal. N.p., 21 Mar. 2008. Web. 14 Oct. 2013.             <http://www.thrombosisjournal.com/content/6/1/2>.