Peripheral neuropathy and folate deficiency as the first sign of Crohn's disease

Peripheral neuropathy and gastroenterologic disorders: an overview on an underrecognized association

BACKGROUND AND AIM OF THE WORK

Although peripheral neuropathies in children are often of genetic origin, acquired causes should be carefully looked for and ruled out also in the pediatric age. Gastroenterological disorders can be complicated by peripheral neuropathy as a result of micronutrients deficiency, drug toxicity or because of shared pathophysiological mechanisms.

METHODS

In this descriptive review we sought to give an overview on the most relevant clinical conditions in which peripheral neuropathies are associated with gastro-intestinal disorders or symptoms.

RESULTS

We describe the clinical, demographic, and electrophysiological features of peripheral neuropathy in three main clinical scenarios: in the context of common gastroenterological disorders (inflammatory bowel and celiac disease), in the context of micronutrients deficiencies arising from malabsorption irrespective of etiology, and in a rare degenerative mitochondrial disorder, mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) disorder.

CONCLUSIONS

The association between gastrointestinal and peripheral nervous system symptoms is probably still underrecognized but has to be actively sought, in order to provide prompt diagnosis resulting in optimal care and long-term management with the aim to improve quality of life and, at least in some conditions, try to impact on prognosis.

Peripheral neuropathy: an underreported neurologic manifestation of inflammatory bowel disease

BACKGROUND AND AIMS

One of the most frequent neurologic complications reported in inflammatory bowel disease population is peripheral neuropathy; however, clinical aspects of peripheral nerve damage are not well characterized. The aim of the review is to present the existing literature on peripheral neuropathy in inflammatory bowel disease patients.

METHODS

A literature search identified the publications reporting on epidemiology, clinical features, underlying mechanisms and management of ulcerative colitis and Crohn's disease patients with peripheral nerve involvement.

RESULTS

The pathogenesis of peripheral nervous system damage in inflammatory bowel disease has yet to be elucidated, although it seems to be related to immune mechanisms; therefore, treatment with immunotherapy is recommended. In addition, peripheral neuropathy may appear as iatrogenic-related disorders associated with several drugs used in controlling inflammatory bowel disease activity; finally, peripheral neuropathy may also be caused by micronutrient deficiencies secondary to malabsorption-related disorders.

CONCLUSIONS

Although peripheral nervous nerve damage associated with inflammatory bowel disease is rarely reported, clinicians should be aware of the peripheral neuropathy clinical manifestations in order to recognize it and provide early treatment, which is crucial for preventing major neurologic morbidity. Heightened awareness is necessary for the successful management of these patients.

Neurologic disorders associated with inflammatory bowel disease

BACKGROUND AND PURPOSE

the study is aimed to report neurologic manifestations in a population of patients with inflammatory bowel disease in order to address its clinical characteristics.

METHODS

we conducted a retrospective study based on a computer-guided search, of patients with Crohn's disease or ulcerative colitis diagnosed at three hospitals in Spain spanning from 2000 through 2008. Patients were classified into different clinical groups based on the type of neurologic involvement. Only patients without iatrogenic complications, vitamin deficiencies, or known cerebrovascular risk factors were included.

RESULTS

we identified and reviewed the records of eighty-four inflammatory bowel disease patients with neurologic symptoms: thirteen patients with ulcerative colitis and twelve patients with Crohn's disease associated with neurologic complications were identified. Their ages ranged from 17 to 74 years. There was a slight predominance of women. Only four of them have another extra-intestinal manifestation. Most of the patients developed neurologic manifestations coincidental or after digestive symptoms appeared. Demyelinating disease was the most frequent manifestation observed (8 patients). Cerebrovascular, peripheral nerve, and epilepsy disorders were diagnosed in 6, 5, and 3 patients, respectively. One patient with myoclonus, one with amyotrophic lateral sclerosis, and one with sensorineural hearing loss were found.

CONCLUSIONS

although an incidence could not be obtained, this population of patients with inflammatory bowel disease have a low frequency of severe neurologic disorders. Neurologic diseases, such as cerebrovascular disease, demyelinating disease, and peripheral neuropathy, could be associated with Crohn's disease and ulcerative colitis.

[Neurological complications of inflammatory bowel disease]

Although ulcerative colitis and Crohn's disease have traditionally been considered to be inflammatory diseases limited to the gastrointestinal tract, it has been shown that both pathologies are frequently accompanied by various extraintestinal disorders. There is an increasing evidence that they may also manifest in the nervous system, including the peripheral and the central parts. Although some of these neurological complications have been known for a long time, such as cerebrovascular disease, vasculitis and autoinmune processes including neuropathies and cerebral demyelination, others have been recently described. With the exception of some of this complications such as the thromboembolism, evidence for a casual relationship relies merely on single case reports or case series. In this article, we try to review the existing evidence on neurological manifestations of both variants of inflammatory bowel disease.

Peripheral neuropathy as first sign of ulcerative colitis in a child

A 6-year-old girl developed an axonal sensorimotor polyneuropathy a few days before intestinal symptoms with bloody diarrhea and abdominal pain. Colon biopsy established the diagnosis of ulcerative colitis. Vitamin and acid folic levels were normal. Peripheral neuropathy is an unusual event in ulcerative colitis in childhood, and an autoimmune pathogenesis is suspected.

Sensory neuropathy associated with metronidazole: report of four cases and review of the literature

OBJECTIVE

To better characterize sensory neuropathy associated with metronidazole.

METHODS

We report four patients who developed dysesthesias after metronidazole treatment. One received topical metronidazole only. All four underwent electrodiagnostic studies, including nerve conduction studies (NCS), quantitative sensory testing (QST), and quantitative sudomotor axon reflex testing (QSART). One underwent nerve biopsy.

RESULTS

NCS were normal in all patients. QST showed impaired vibration thresholds in three patients. Three of four patients had abnormal tests of small fiber function. Cooling thresholds were abnormal in one; QSART was abnormal in one and borderline in another. The nerve biopsy specimen showed mild loss of small myelinated axons.

CONCLUSIONS

This study shows that paresthesias associated with metronidazole exposure may be the result of a relatively mild sensory neuropathy with predominant involvement of small fibers and milder, mostly subclinical involvement of large fibers.

[Sensorimotor polyneuropathy in a flare-up of Crohn disease]

A 22-year-old man developed an axonal sensorimotor polyneuropathy and an episode of pyloroduodenal stenosis at the same time. Rectal biopsy established the diagnosis of Crohn's disease. The etiologic investigations were negative. The neurological and gastrointestinal troubles improved and followed a parallel course. Without vitamin deficiency or metronidazole treatment, peripheral polyneuropathy is a rare event in Crohn's disease. An autoimmune cause is suspected.