Large-artery stroke in a young patient with Crohn's disease. Role of vitamin B6 deficiency-induced hyperhomocysteinemia.
An increased incidence of ischemic stroke has been reported in patients with Crohn's disease. Cerebral infarcts are usually considered as a complication of the hypercoagulable state associated with this inflammatory bowel disease (IBD). The association between Crohn's disease, hyperhomocysteinemia and large-artery stroke of the young has rarely been reported. A 39-year-old woman, with prior medical history of Crohn's disease and hypertension, presented with an ischemic stroke of the left internal carotid artery (ICA) territory. Etiological workup disclosed bilateral high-grade ICA stenosis and atheroma of the subclavian and vertebral arteries. Exhaustive search for prothrombotic factors showed inflammation, with an increased level of fibrinogen and factor IX, and a marked hyperhomocysteinemia. Both vitamin B1 and vitamin B6 plasmatic levels were decreased. Heterozygous C677T methylene-tetrahydrofolate reductase gene mutation was present. This observation highlights the combined proatherogenic effect of vitamin B deficiency-induced hyperhomocysteinemia and inflammation leading to large-artery stroke of the young in the setting of Crohn's disease. Our case report stresses the importance of vitamin deficiency screening in patients with IBD in terms of stroke prevention.
Younes-Mhenni
S
S
Service d'Urgences NeuroVasculaires, Hôpital Neurologique, 59 Boulevard Pinel, 69003 Lyon, France.
Derex
L
L
Berruyer
M
M
Nighoghossian
N
N
Philippeau
F
F
Salzmann
M
M
Trouillas
P
P
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002539:Cerebral Arterial Diseases / Q000209:etiology*; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications* / Q000188:drug therapy; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D019804:Mesalamine / Q000627:therapeutic use; D020768:Middle Cerebral Artery; D019821:Simvastatin / Q000627:therapeutic use; D013831:Thiamine / Q000627:therapeutic use; D016896:Treatment Outcome; D025101:Vitamin B 6 / Q000627:therapeutic use; D014804:Vitamin B Deficiency / Q000150:complications* / Q000188:drug therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine; D025101:Vitamin B 6; D019821:Simvastatin; D013831:Thiamine