Histologically confirmed case of cerebral vasculitis associated with Crohn's disease -a case report

Masayuki Gekka, Taku Sugiyama, Masafumi Nomura, Yasutaka Kato, Hiroshi Nishihara, Katsuyuki Asaoka

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish
Article number169
JournalBMC Neurology
Volume15
Issue number1
DOIs
Publication statusPublished - 2015 Sep 21
Externally publishedYes

Fingerprint

Central Nervous System Vasculitis
Crohn Disease
Hypoproteinemia
C-Reactive Protein
Gerstmann Syndrome
Angiography
Magnetic Resonance Imaging
Anterior Cerebral Artery
Mesalamine
Parietal Lobe
Azathioprine
Middle Cerebral Artery
Prednisolone
Fever
Catheters
Biopsy

Keywords

  • Central nervous system
  • Crohn's disease
  • Inflammatory bowel disease
  • Neurological involvement
  • Vasculiti

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Histologically confirmed case of cerebral vasculitis associated with Crohn's disease -a case report. / Gekka, Masayuki; Sugiyama, Taku; Nomura, Masafumi; Kato, Yasutaka; Nishihara, Hiroshi; Asaoka, Katsuyuki.

In: BMC Neurology, Vol. 15, No. 1, 169, 21.09.2015.

Research output: Contribution to journalArticle

Gekka, Masayuki ; Sugiyama, Taku ; Nomura, Masafumi ; Kato, Yasutaka ; Nishihara, Hiroshi ; Asaoka, Katsuyuki. / Histologically confirmed case of cerebral vasculitis associated with Crohn's disease -a case report. In: BMC Neurology. 2015 ; Vol. 15, No. 1.
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