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

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.

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.

An unexpected and severe neurological disorder with permanent disability acquired during short-course treatment with metronidazole

A case is reported of permanent sensorimotor distal polyneuropathy combined with sensory hemisymptoms in a middle-aged woman after only 10 g of metronidazole given as 400 mg, three times daily for 9 d. The disability is still permanent after 22 months of observation. No other cause has been found.

[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.