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Stroke in paediatric Crohn's disease
Sai Anjali Kambala1, Seema Pavaman Sindgikar2, Daniya Hameed1
1Paediatrics, Nitte (Deemed to be University), KS Hegde Medical Academy (KSHEMA), Mangalore, Karntaka, India.
Insights
This case study highlights a rare neurological complication in Crohn's disease (CD). Prompt treatment with infliximab led to remission of CD and recovery from stroke-related deficits.
Area of Science:
- Neurology
- Gastroenterology
- Immunology
Background:
- Neurological complications in inflammatory bowel disease (IBD) are uncommon but significantly increase patient morbidity.
- Poorly controlled IBD, characterized by recurrent disease flares, elevates the risk of neurological sequelae.
- Crohn's disease (CD) management can be challenging, particularly in adolescents with treatment-resistant disease.
Purpose of the Study:
- To present a case of a rare neurological complication, specifically a stroke, in an adolescent with difficult-to-treat Crohn's disease.
- To illustrate the diagnostic and therapeutic challenges in managing such complex cases.
- To emphasize the importance of timely and appropriate treatment for both the underlying IBD and its neurological complications.
Main Methods:
- A detailed case report of an adolescent female diagnosed with Crohn's disease.
- Review of her clinical history, including recurrent gastrointestinal symptoms and previous treatment attempts.
- Neuroimaging (including angiography) to evaluate the stroke and associated venous sinus thrombosis.
- Initiation of emergency stabilization with antiepileptics and anticoagulants, followed by infliximab therapy during rehabilitation.
Main Results:
- The patient experienced a haemorrhagic stroke with infarction, superior sagittal sinus thrombosis, and left transverse sinus thrombosis during a Crohn's disease flare-up.
- Despite initial financial constraints preventing biological therapy, the patient was eventually treated with infliximab.
- Following treatment, the patient achieved partial remission of Crohn's disease, with complete recovery of facial and limb neurological deficits.
Conclusions:
- This case underscores the potential for severe neurological complications, such as stroke, in patients with inflammatory bowel disease, particularly during disease flares.
- Effective management of the underlying inflammatory bowel disease, including the use of biological agents like infliximab, is crucial for preventing and treating these complications.
- Early diagnosis and multidisciplinary management are essential for improving outcomes in IBD patients with neurological involvement.
Abstract:
Neurological complications in inflammatory bowel disease are rare but can increase morbidity. The risk is higher in poorly controlled disease with recurrent flare-ups.We discuss an adolescent girl with difficult-to-treat Crohn's disease (CD) complicated by haemorrhagic stroke. While she was under treatment for an episode of flare-up, she developed haemiparesis, facial nerve palsy and focal seizures. In the past, she had experienced multiple admissions for recurrent abdominal pain and altered bowel habits. A thorough evaluation confirmed the diagnosis of CD. Though her disease status required administration of biologicals in the initial phase, due to financial constraints, it was not possible. In the present admission for a relapse, she developed a stroke. Neuroimaging with angiography suggested infarction with haemorrhagic transformation in the left posterior parietal lobe and thrombosis of the superior sagittal sinus and left transverse sinus.Emergency stabilisation was done with antiepileptics and anticoagulants. She was initiated on infliximab during the rehabilitation phase. The primary disease is under partial remission, and facial and limb weaknesses have recovered completely.
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