Cerebral Venous Sinus Thrombosis in a Patient with Ulcerative Colitis Flare

Table 1

Risk dactors for CVT [6].

Condition	Prevalence,	Consistency^1†	Strength of association^2† OR (95% CI)	Biological plausability^3†	Temporality^4†	Biological gradient^5†
Prothrombotic conditions	34.1
Antithrombin III deficiency		Yes	NA	Yes	Yes	Yes^ǂ
Protein C deficiency		Yes	11.1 (1.9–66.0)	Yes	Yes	Yes^ǂ
Protein S deficiency		Yes	12.5 (1.5–107.3)	Yes	Yes	Yes^ǂ
Antiphospholipid and		Yes	8.8 (1.3–57.4	Yes	Yes	Yes^ǂ
anticardiolipin antibodies	5.9	Yes		Yes	Yes	Yes^ǂ
Resistance to activated protein C and		Yes	3.4 (2.3–5.1)	Yes	Yes	Yes^ǂ
and factor V Leiden
Mutation G20210A of Factor II		Yes	9.3 (5.9–14.7)	Yes	Yes	Yes^ǂ
Hyperhomocysteinemia		Yes	4.6 (1.6–12.0)	Yes	Yes	Yes^ǂ
Pregnancy and puerperium	21	Yes	NA	Yes	Yes	NA
Oral Contraceptives	54.3	Yes	5.6 (4.0–7.9)	Yes	Yes	Yes
Drugs
Androgen, danazol, lithium, vitamin A,	7.5		NA	Yes	Yes	NA
IV immunoglobulin, ecstasy
Cancer related	7.4	Yes	NA	Yes	Yes	NA
Local compression
Hypercoagulable
Antineoplastic drugs (tamoxifen, L-asparaginase)
Infection	12.3		NA	Yes	Yes	NA
Parameningeal infections (ear,		Yes
sinus, mouth, face, and neck)
Mechanical precipitants	4.5	Yes	NA	Yes	Yes	NA
Complication of epidural blood patch
Spontaneous intracranial hypotension
Lumbar puncture
Other hematologic disorders	12	Yes	NA	Yes	Yes	NA
Paroxysmal nocturnal hemoglobinuria
Iron deficiency anemia		Yes		Yes	Yes	NA
Nephrotic syndrome	0.6
Polycythemia, thrombocytopenia	2.8
Systemic diseases	7.2	Yes	NA	Yes	Yes	NA
Systemic lupus erythematous	1
Baçet disease	1
Inflammatory bowel disease	1.6
Thyroid disease	1.7
Sarcoidosis	0.2
Other	1.7
None Identified	12.5		NA	NA	NA	NA

CVT: cerebral venous thrombosis; OR: odds ratio; CI: confidence interval; NA: nonapplicable/nonavailable; IV: intravenous. as per Ferro et al. Percentages for CVT associated with oral contraceptives or pregnancy/puerperium are reported among 381 women ≤ 50 years of age. ^†Cause-and-effect relationship determined as follows: (1) consistency of association: has the association been repeatedly observed by different investigators (yes/no)? (2) Strength of association: how strong is the effect (relative risk or OR)? (3) Biological plausibility: does the association make sense, and can it be explained pathophysiologically (yes/no)? (4) Temporality: does exposure precede adverse outcome (yes/no)? (5) Biological gradient: does a dose-response relationship exist (yes/no)? Evidence of a strong and consistent association, evidence of biological plausibility, a notable risk of recurrent events, and detection of a biological gradient are suggestive of causation rather than association by chance alone. Modified from Grimes and Schulz. Copyright ©2002 Elsevier. ^ǂ Evidence for the biologic gradient is not specific for CVT but for VTE.