This is a 53-year-old male, with no toxic habits, whose history included the presence of hypertension and the diagnosis, fifteen years before, of an IBD type EC (stage A2 L Montreal classification Ileal Resection first).
The last admission due to colitis had taken place 5 years earlier. Since then, the patient has been treated with oral contraceptives (1 g/8 hours) and beta-blockers (4 g/24 hours).
She suffered from right hemicraneal headache of a week of evolution with organic characteristics, accompanied by dysarthria and behavioral changes.
He also reported a certain increase in the usual number of stools, although without pathological products, abdominal pain or other symptoms suggestive of IBD activity.
During his observation in the Emergency Department he presented up to four seizures with partial simple seizures with clonic movements of the left limbs.
The general physical examination revealed fever, while the neurological examination showed a patient, inattentive, bradykinesia and mental hyperactivity, with a tendency to somnolence and normal language, mild left central facial paresis and hemianopsia.
The hemogram showed macrocytic anemia (hemoglobin: 19.1 g/dl; mean corpuscular volume: 103; biochemical and basic coagulation study were normal.
Computed tomography (CT) identified a right temporal cortico-subcortical hypodensity suggestive of subacute infarction; CT angiography confirmed the presence of a right transverse cerebral venous defect.
After starting anticoagulant therapy (heparin non-selected) and anticonvulsant medication, the patient was admitted to the hospital to complete the study.
The erythrocyte sedimentation rate (56 mm in the first hour) and C-reactive protein (3.4 mg/dl; normal: 0.0-0.8 mg/dl) were slightly elevated, while the markers of serum folic acid or serum levels were normal.
Brain magnetic resonance angiography (NMR-angiography) revealed absence of flow in the right transverse and sigmoid sinuses, with contrast uptake in the adjacent dura mater and presence of the "delta sign".
After confirming the diagnosis of CHF with secondary right temporal venous infarction, the patient was discharged and sent home under treatment with levetiracetam and acenocoumarol.
At 6 months of the homozygous mutation (20 70% genotype II) a complete study of hypercoagulability was requested, after suspension of anticoagulant therapy, which showed a decrease in the levels of chromogenic CP (61%; normal: 70-120%) and normal: S-16 protein.
In order to confirm this finding, this study was repeated after another 6 months, with similar results (chromogenic CP: 70%; anticoagulant CP: 73%), reason why it was decided to maintain the coumarin treatment.
After 14 months of follow-up the patient remains asymptomatic from the neurological point of view and without evidence of thrombotic recurrence or sprout of CD activity.
