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01.12.2015 | Case report | Ausgabe 1/2015 Open Access

BMC Neurology 1/2015

Histologically confirmed case of cerebral vasculitis associated with Crohn’s disease –a case report

Zeitschrift:
BMC Neurology > Ausgabe 1/2015
Autoren:
Masayuki Gekka, Taku Sugiyama, Masafumi Nomura, Yasutaka Kato, Hiroshi Nishihara, Katsuyuki Asaoka
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

All authors (MG, TS, MN, YK, HN and KA) contributed to the design of the study, and the interpretation of data. Furthermore, all authors read and approved the final manuscript. MG acquired the data, drafted the manuscript and created the figure. TS critically revised the manuscript, updated figure and helped acquiring the data. MN, and YK revised the manuscript for important intellectual content and helped creating the figure. HN and KA helped to draft the manuscript.

Abstract

Background

Extraintestinal manifestations in Crohn’s disease (CD) are frequent and well recognized. However, neurological involvement secondary to CD is rare, and there have been few histologically confirmed cases of cerebral vasculitis secondary to CD.

Case presentation

A 58-year-old left-handed man with a history of refractory CD who had fever of over 38 °C, progression of CD symptoms, and Gerstmann’s syndrome consulted our hospital. Laboratory data showed elevation of C-reactive protein (CRP) and hypoproteinemia. T2-weighted magnetic resonance imaging (MRI) revealed a right parietal high-intensity lesion. Catheter angiography showed segmental multiple narrowing and occlusion in the distal part of the middle cerebral artery and anterior cerebral artery. Angiography also revealed multiple venous occlusions in the affected parietal area. To confirm the diagnosis, the patient underwent open biopsy, and histological examination revealed cerebral vasculitis. The patient was then started on high-dose prednisolone (60 mg/day) in addition to his previous therapy, which included mesalazine, adalimumab, and azathioprine. CRP elevation, hypoproteinemia, and gastrointestinal symptoms immediately improved after starting this treatment. Neurological status improved simultaneously with CD symptom improvement, and follow-up brain MRI revealed a reduction in the size of the right parietal lobe lesion. He returned to normal status and was discharged from our hospital 5 weeks after admission.

Conclusion

This is an important case of histologically confirmed cerebral vasculitis associated with CD. The clinical course of our case clearly illustrates the relevance of the occurrence of cerebral vasculitis and the exacerbation of CD.
Literatur
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