Headache and CNS white matter abnormalities associated with gluten sensitivity

Hadjivassiliou, Marios; Grünewald, Richard A.; Lawden, Mark; Davies‐Jones, G.A.B.; Powell, T.; Smith, Christine M.

doi:10.1212/wnl.56.3.385

Cited by 129 publications

(106 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The patients res pon ded to low glu ten di et in dif fe rent le vels, and three of the se pati ents we re di ag no sed with CD. 2 Ki es lich et al 15 obser ved fo cal whi te mat ter le si ons in the bra in MRI of 20% of the chil dren who had CD di ag no sis and neu ro lo gic in vol ve ment. 15 Our pa ti ent's first gas tro in tes ti nal symptom occur red two ye ars af ter the di ag no sis of MS. Si mi larly in pre vi o usly re por ted ca ses, CD, when ac com pa ni ed by anot her au to im mu ne di se a se, is ge ne rally "si lent" for a ti me pe ri od.…”

Section: Discussionmentioning

confidence: 99%

“…Wit hin this pe ri od, CD which do es not show any cli ni cal symptom is na med as "silent CD". 2,3 The au to im mu ne di se a se ac com pan ying CD im pro ve with a glu ten-fre e di et. 2,3 Mul tip le scle ro sis and CD are both Th1 me di ated di se a ses and re cent da ta sug gest that a de fect in a re gu la tory T cell sub set (CD4…”

Section: Discussionmentioning

confidence: 99%

“…1 Recently, white matter lesions have been described in CD patients with headache in brain magnetic resonance imaging (MRI). 2,3 It is suggested that these white matter lesions are "multiple sclerosis like diseases" 2,3 and that there can be an association between CD and multiple sclerosis (MS). To further investigate this observation, small intestine biopsy studies were carried out in patients with MS; yet no symptoms that could be associated with CD were found.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Association of Multiple Sclerosis and Celiac Disease: Case Report

Uludağ¹,

Kulu²,

Şener³

et al. 2011

Turkiye Klinikleri J Med Sci

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Association of Multiple Sclerosis and Celiac Disease: Case Report

Uludağ¹,

Kulu²,

Şener³

et al. 2011

Turkiye Klinikleri J Med Sci

View full text Add to dashboard Cite

“…Nonspecific periventricular white matter lesions of various sizes with increased T2/FLAIR signal intensity and without enhancement have been described. 9,10 The lesions may be unilateral and bilateral. 11 Occipital calcifications have also been reported.…”

Section: Discussionmentioning

confidence: 99%

White Matter Lesions Suggestive of Amyotrophic Lateral Sclerosis Attributed to Celiac Disease

Brown¹,

Jewells²,

Herfarth

et al. 2009

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

SUMMARY:CD is an autoimmune-mediated disorder of the gastrointestinal tract. Initial symptom presentation is variable and can include neurologic manifestations that may comprise ataxia, neuropathy, dizziness, epilepsy, and cortical calcifications rather than gastrointestinal-hindering diagnosis and management. We present a case of a young man with progressive neurologic symptoms and brain MR imaging findings worrisome for ALS. During the diagnostic work-up, endomysium antibodies were discovered, and CD was confirmed by upper gastrointestinal endoscopy with duodenal biopsies. MR imaging findings suggestive of ALS improved after gluten-free diet institution.ABBREVIATIONS: ALS ϭ amyotrophic lateral sclerosis; CD ϭ celiac disease; FLAIR ϭ fluid-attenuated inversion recovery; IgA ϭ immunoglobulin A C D is an inflammatory condition of the small intestine also called celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. The most common presenting symptoms include diarrhea, steatorrhea, weight loss, iron deficiency anemia, and abdominal distension. Imaging findings specific to the brain have been reported primarily involving the periventricular white matter. Case ReportA 32-year-old man with a 1-year history of balance difficulties presented with 1 week of worsening symptoms, including hand tremors and gait disturbance. Admission review of systems revealed a 60-pound (27.22 kg) weight loss during the past year, which he attributed to diarrhea consisting of 3-4 loose stools per day. Physical examination showed a broad-based gait leaning to the right, dysmetria with right finger-to-nose, hyperreflexia, an upgoing right toe, right lower extremity weakness, and right foot drop. Sensation was normal. Laboratory studies revealed a slightly elevated phosphorus concentration (4.8 mg/dL), but findings were otherwise normal. Brain MR imaging showed abnormal increased signal intensity on T2 and FLAIR in the bilateral corona radiata, extending inferiorly into the corticospinal tracts without contrast enhancement (Fig 1).Initial diagnostic considerations included ALS and Friedrich ataxia. Electromyelography findings of the right upper and lower extremities were normal. Total spine MR imaging and CT findings of the chest, abdomen, and pelvis were normal. CSF findings for herpes simplex virus, human herpesvirus 6 cytomegalovirus, varicella-zoster virus, Epstein-Barr virus, and Venereal Disease Research Laboratory test were negative, but ϩ4 oligoclonal bands were noted. Findings were negative for paraneoplastic antibodies. Ataxia work-up included a positive antiendomysial antibody titer of 1:160. Duodenal biopsies yielded crypt hyperplastic villous atrophy with numerous intraepithelial lymphocytes, most consistent with gluten-sensitive enteropathy.The patient started a strict gluten-free diet with improvement of symptoms during the next several months. Repeat brain MR imaging (23 months after initial presentation) revealed resolution of initial abnormalities (Fig 2). Continued physical therapy and a gluten-free diet have b...

show abstract

“…Some neurological complications such as ataxia, peripheral neuropathy, and epilepsy are wellrecognized [3]. However, neurological symptoms with white matter lesions (WMLs) in brain imaging without specific underlying etiology is a less recognized variant [4,5]. Here we describe a patient who suffered from unexplained neurological symptoms without accompanying gastrointestinal manifestations and with brain MRI showing WMLs who was found, after extensive work up, to have CD.…”

Section: Introductionmentioning

confidence: 98%

Celiac Disease Hiding Behind Cerebral White Matter Lesions: A Case Report

Venkatraman¹

2017

IJCD

View full text Add to dashboard Cite

Celiac disease, or celiac enteropathy, is a relatively common autoimmune disease with myriad of presentations, including intestinal and extra-intestinal manifestations. It is also a less common cause of cerebral white matter lesions in the absence of other etiologies. If such patients are symptomatic, diagnosis can be challenging, especially when gastrointestinal symptoms are absent. The differential diagnosis in such cases is wide and high index of suspicion is needed to make the diagnosis. We presented a case of celiac disease who presented with neurological symptoms and white matter lesions in brain magnetic resonance imaging without gastrointestinal symptoms.

show abstract

Headache and CNS white matter abnormalities associated with gluten sensitivity

Cited by 129 publications

References 8 publications

Association of Multiple Sclerosis and Celiac Disease: Case Report

Association of Multiple Sclerosis and Celiac Disease: Case Report

White Matter Lesions Suggestive of Amyotrophic Lateral Sclerosis Attributed to Celiac Disease

Celiac Disease Hiding Behind Cerebral White Matter Lesions: A Case Report

Contact Info

Product

Resources

About