Cerebral thromboembolic events in pediatric patients with inflammatory bowel disease.
BACKGROUND
There is a recognized association between pediatric inflammatory bowel disease (IBD) and cerebral thromboembolic events (CTEs). Historical reporting had described the association as strongest between ulcerative colitis (UC), rather than Crohn's disease (CD). We describe the incidence and outcome of CTE in pediatric IBD patients from a single center over 5 years and the relative proportion of stroke reported in the literature in patients with UC and CD before and after January 2000.


METHODS
Demographic data were extracted on all newly diagnosed cases of IBD in our center from January 2003 to January 2008 to ascertain patient characteristics, disease type, risk factors for CTE, modality of neuroimaging, and outcome. A literature search was performed to identify all articles describing stroke in pediatric IBD. All identified studies were stratified into those published before and after January 1 2000.


RESULTS
In all, 154 new patients diagnosed with IBD (male 56%) (UC 30%, CD 64%, IBD unclassified [IBDU] 6%) were reviewed. Four cases of CTE occurred in our population over 5 years (2.6%). All patients had a risk factor for CTE. Fifteen case series were identified with 32 patients. There was a significant increase in the proportion strokes affecting patients with CD reported after January 2000 (P = 0.02).


CONCLUSIONS
CTE affects a proportion of pediatric IBD patients. Although resolution of physical impairment is the norm, significant morbidity exists. Our study suggests a secular trend toward CTE in CD. Primary prevention with the identification and amelioration of identifiable risk factors should be the clinical objective in future studies.
Barclay
A R
AR
Division of Developmental Medicine, University of Glasgow, Glasgow, UK. A.Barclay@clinmed.gla.ac.uk
Keightley
J M
JM
Horrocks
I
I
Garrick
V
V
McGrogan
P
P
Russell
R K
RK
D000293:Adolescent; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D020767:Intracranial Thrombosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D012307:Risk Factors