Neurological manifestations of celiac disease.
Celiac disease (CD/ Nontropicalsprue, gluten-sensitive enteropathy) is a malabsortive condition in which an allergic reaction to the cereal grain-protein gluten (present in wheat, rye and barley) causes small intestine mucosal injury. The onset is in the first four decades of life, with a female to male ratio of 2:1. It may be associated with a wide spectrum of neurological manifestations including cerebellar ataxia, epileptic seizures, dementia, neuropathy, myopathy and multifocal leucoencephalopathy. We report three patients with neurological manifestations related with CD: one with cerebellar ataxia, one with epilepsy and one with cognitive impairment. The diagnosis of CD was confirmed by serologic tests (antiendomysial and antigliadin antibodies) and biopsy of the small intestine. In two patients the neurological symptoms preceded the gastrointestinal abnormalities and in all of them gluten restriction failed to improve the neurological disability.


CONCLUSIONS
CD should be ruled out in the differential diagnosis of neurological dysfunction of unknown cause, including ataxia, epilepsy and dementia. A gluten free diet, the mainstay of treatment, failed to improve the neurological disability.
Siqueira Neto
José Ibiapina
JI
Department of Internal Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
Costa
Ana Carolina Leite Vieira
AC
Magalhães
Francisco George
FG
Silva
Gisele Sampaio
GS
D000328:Adult; D017677:Age Distribution; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D002524:Cerebellar Ataxia / Q000209:etiology; D003937:Diagnosis, Differential; D004827:Epilepsy / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D009460:Neurologic Examination; D017678:Sex Distribution