Stroke in paediatric Crohn's disease.

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.