Cerebral Sinus Thrombosis: A Fatal Neurological Complication of Ulcerative Colitis

Ulcerative colitis is not only a challenging and distressing disease but in a few cases, it can prove to be more dangerous than one would have even thought of. Ulcerative colitis is a chronic inflammatory bowel disease which affects the large intestine’s inner lining resulting in inflammation and then ulceration. It is manifested through various signs and symptoms, i.e. diarrhea, blood and mucus in stools, weight loss, abdominal pain, and general debilitation. People of any age group can get affected by this disease, but the 15-30 age group is more prone to it. You might have heard many of its complications like severe bleeding, perforation of the colon, osteoporosis, toxic megacolon, etc. But only a few might be aware of its rare but most fatal complication, i.e. Cerebral sinus thrombosis.  A cerebral venous sinus thrombosis is a condition characterized by the presence of a blood clot in the dural venous sinuses. The function of the dural venous sinus is to drain blood from the brain and the presence of blood clot in its passage blocks the blood flow of the brain. Now you might have evaluated and analyzed that how bad it is to have cerebral sinus thrombosis.

However, its occurrence is rare in ulcerative colitis, but even though it covers around 7.5% patient population suffering from ulcerative colitis. Studies suggest that it might be due to the genetic predisposition and hypercoagulation which occurs during relapse of the ulcerative colitis. Patients suffering from Cerebral sinus thrombosis as a complication of ulcerative colitis present with typical symptoms of this disease. Diagnosis is made when the recent aggravation of ulcerative colitis presented with signs and symptoms cerebral sinus thrombosis, i.e. headache, vision abnormalities, weakness of limbs and face usually one-sided, numbness, hemiparesthesia, and seizures. Other CNS manifestations in UC patients can be cerebral vasculitis, cerebrovascular disease, multiple sclerosis, myelopathy, and acute disseminated encephalomyelitis. Not only UC patients but overall if seen, then any IBD patient has a chance of developing Cerebral sinus venous thrombosis (CSVT) but however in UC patients it is more common due to the presence of hypercoagulable state during relapses of the disease. Diagnosis is usually delayed in this disease because of its rare occurrence and due to the late diagnosis, the prognosis becomes poor and the patient usually dies. It can be a rare complication but is very devastating when compared to other complications. Any patient who is presenting with neurological signs and symptoms should be screened for CSVT.

Hypercoagulation in UC patients, causing CSVT is the result various factors like elevated levels of fibrinogen, factor VIII (FVIII- an essential protein responsible for blood clotting), decreased antithrombin, protein C and protein S. Other than this hypofibrinolysis, abnormal platelets, dysfunction in endothelial factor, and immunological abnormalities. CSVT is a cause of concern as it has increased the rate of mortality in UC patients. Hence, acute exacerbation in UC followed by a headache which is increasing day by day should be suspected for CSVT and diagnosed as early as possible. Early diagnosis is the only way to improve prognosis.

Ayurveda has come up as a rescuing system of medicine for patients suffering from ulcerative colitis. The ayurvedic perspective of disease and body system is different from modern medicine. In case of CSVT as per Ayurveda it is correlated with Vatharaktham and siragrandhi. According to the Ayurvedic system of medicine, there are three doshas which govern the functioning of the body, i.e.  Vata, Pitta and Kapha dosha and any deviation from normal in their being disturb the body functioning and causes disease. In this case, there is an imbalance of Vata, Pitta dosha along with vitiation of Rakta dhatu. Here treatment is based on treating the disease from the root cause and varies for every individual. Individuality is necessary for the mode of treatment as the body of every person is different, hence the response to disease is different so should be the way to treating it. To correct the aggravated doshas some herbs can be used which have a specific action on its pathogenesis.

1. Arjuna- This herb has a blood thinning action and hence can be used to treat the CSVT. It helps to dissolve the clot present in the venous channel and hence prevents any serious outcomes. However, it is considered as the heart tonic due to its amazing effect on the heart and helps to treat any kind of cardiovascular diseases. It slows down the platelet aggregation and lowers the risk of formation of thrombosis in blood vessels.
2. Amla- It is the highest source of vitamin C and works efficiently to improve the number of red blood cells. It decreases the aggravated Pitta in the body without causing any negative effects on Vata and Kapha Dosha. Amalaki is one of the rasayana and can help to treat CSVT in a very natural way.
3. Garlic- Used widely in Indian kitchens and possesses many health benefits, one of them is preventing blood clot formation in blood vessels. It possesses certain anti-blood clotting compounds which can help to treat CSVT very naturally.
4. Ginger- It is a potent anti-inflammatory and anti-blood coagulating herb which helps to prevent the abnormal clotting of blood. Natural salicylates present in ginger works in thinning the blood and preventing blood coagulation.
5. Turmeric- Curcumin is the active compound of turmeric, which works as the anti-inflammatory and anticoagulant. It thins the blood naturally without causing any bad effects on the body and hence can be used to treat CSVT.
6. Grape seed extract- This is also a potent natural anti-thrombotic substance which prevents the formation of thrombosis in the blood vessels. It is a natural blood thinner and clears the blood clot present anywhere in the body.

Hence, these herbs are used in Ayurveda for treating thrombosis and embolism. Similarly, it can be used in treating CSVT naturally. But if taken in raw form won’t be so effective as compared when taken in the form of Ayurvedic medicine. In Planet Ayurveda various herbal medicines are prepared using these herbs and possess a natural, pure extracts of these herbs, many more times effective than the raw herb. Hence, for CSVT you can go with the herbal products like curcumin capsules, Amalaki rasayan, Arjuna capsules and many more. These herbal medicines can help to treat CSVT naturally without causing any harm to the body.

The key to long-lasting and effective treatment is early diagnosis and proper mode of treatment which is gentle, quick, and won’t pose any other risk to the body.