Crohns disease with central nervous system vasculitis causing subarachnoid hemorrhage due to aneurysm and cerebral ischemic stroke

Abstract

Cerebral vasculitis secondary to Crohn's disease (CD) seems to be a very rare phenomenon. We report a 39-year-old male who presented with headache, vomiting, and left-sided weakness in the known case of CD. Cross-sectional imaging (computed tomography and magnetic resonance imaging,) showed right gangliocapsular acute infarct with supraclinoid cistern subarachnoid hemorrhage (SAH). Cerebral digital substraction angiography (DSA) showed dilatation and narrowing of right distal internal carotid artery (ICA). Left ICA was chronically occluded. His inflammatory markers were significantly raised. Imaging features are suggestive of cerebral vasculitis. Arterial and venous infarcts due to thrombosis are known in CD. Our case presented with acute subarachnoid hemorrhage in supraclinoid cistern due to rupture of tiny aneurysm of perforator arteries causing SAH and infarction in right basal ganglia. Patient was treated conservatively with immunosuppression along with medical management of SAH.

Early interventional embolization in the treatment of cerebral aneurysm rupture

“…Cerebral aneurysm has many hazards. Delayed treatment may result in high risks of disability and death 12. Surgical clipping is easy to cause large trauma to patients previously and has complex operation; moreover multiple complications appear after surgery.…”

Differential Diagnosis between Primary Intracranial Melanoma and Cerebral Cavernoma in Crohn’s Disease: A Case Report and Literature Review

“…Metastatic melanoma has a median survival time of 113 days. In the presented case, the patient was treated for Crohn's disease with adalimumab, and according to recent studies, there is a plausible connection between IBD therapies and development of melanoma, especially in patients treated with anti-TNF alpha biologics [3]. These therapies compromise the immune surveillance, leading to an increased susceptibility to oncogenic retrovirus infections and to oncogene activation, increasing the risk of melanoma onset.…”

“…This condition promotes a hypo-inflammatory state and may facilitate the development of tumors with a predisposition to prothrombotic events [1]. The use of biologic therapies can also induce systemic vasculitis as a side effect, which, when occurring in the cerebral vascular system, may lead to subarachnoid hemorrhages [3]. As demonstrated, a microbiome alteration can influence the appearance of cavernous bleeding malformation [4].…”

Treatment of CNS Vasculitis in Children

“…Children with organ-specific inflammatory disease such as inflammatory bowel disease can present with CNS vasculitis [62]. Granulomatous vessel wall inflammation resulting in strokes and hemorrhages has been reported [63,64].…”