Neurologic Manifestations of Gastrointestinal Disease

Neurologic presentation of Whipple disease: report of 12 cases and review of the literature

We report 12 cases of Whipple disease in patients with prominent neurologic symptoms, along with 122 cases of Whipple disease with nervous system involvement reported in the literature. We analyzed the clinical signs and results of additional examinations in 2 groups: the first group included patients with predominantly but not exclusively neurologic signs, and the second included patients with clinically isolated neurologic presentation of the disease. Whipple disease is a multisystemic infectious disease due to Tropheryma whippelii that may present with prominent or isolated symptoms of either the central or the peripheral nervous system. Recent reports stress the importance of polymerase chain reaction (PCR) analysis of cerebrospinal fluid, magnetic resonance imaging (MRI) during follow-up, and prolonged antibiotic therapy with drugs able to cross the blood-brain barrier. Cerebrospinal fluid should be analyzed repeatedly during follow-up, and treatment should be discontinued only when the results of PCR assay performed on cerebrospinal fluid are negative. Other examinations to be done include searching for gastrointestinal tract involvement with multiple duodenal biopsies and searching for systemic involvement with lymph node biopsies, which should be analyzed with light microscopy, electron microscopy, and PCR. When all examinations are negative, if Whipple disease is suspected and a lesion is found on brain MRI, a stereotactic cerebral biopsy should be performed. Treating Whipple disease with long-term trimethoprim-sulfamethoxazole is usually effective, but the use of third-generation cephalosporins in case of incomplete response deserves further attention.

[Central neurologic manifestations of Crohn disease]

INTRODUCTION

Neurological involvement in Crohn's disease is unusual.

EXEGESIS

We report two cases of Crohn's disease. Central nervous system deficit was observed in the first patient, while psychiatric disorders were present in the second patient. In both cases, MRI confirmed the presence of a T2 hypersignal in the white matter.

CONCLUSION

Central neurological disorders could either be part of extra-intestinal symptoms in Crohn's disease or precede diagnosis. However, their frequency is not well known or documented. The association of Crohn's disease with multiple sclerosis may obscure the diagnosis. Cerebrovascular accident, seizures, headaches, focal neurological deficits, or sometimes severe psychiatric disorders are encountered. Numerous pathophysiological hypotheses have been advocated. The high frequency of abnormalities that have been observed during systematic MRI provide confirmation of the hypothesis of neurological disorders occurring during Crohn's disease.

[Systemic manifestations of hemorrhagic rectocolitis: apropos of a case of hemorrhagic rectocolitis associated with multiple sclerosis]

Extra-intestinal manifestations of inflammatory bowel diseases are frequent and numerous. We report a case of ulcerative colitis associated with multiple sclerosis, ankylosing spondylitis and pyoderma gangrenosum. This observation shows the rare association of ulcerative colitis-multiple sclerosis, and extra-intestinal manifestations of inflammatory colitis are discussed.