title: Neurologic manifestations of inflammatory bowel diseases.
abstract: Inflammatory bowel diseases (IBD) are chronic, relapsing and remitting inflammatory conditions affecting the digestive system, comprising two main distinctive diseases, ulcerative colitis (UC) and Crohn's disease (CD). Besides the classic gastrointestinal manifestations, a variable number of IBD patients present with extraintestinal manifestations, including central and peripheral nervous system involvement. Peripheral neuropathy is one of the most common complications. An inflammatory myopathy has also been found. Cranial neuropathies include the Melkersson-Rosenthal syndrome, optic neuritis, and sensorineural hearing loss. Patients with IBD have a remarkable thromboembolic tendency and are at increased risk of both venous and arterial thrombotic complications. The prothrombotic state in IBD has multiple contributors. Ischemic stroke occurs through several mechanisms, including large artery disease, small vessel disease, paradoxical embolism, endocarditis, vasculitis, and associated with anti-TNF-α therapy. Thrombosis of the dural sinus and cerebral veins are at least as frequent as arterial stroke in IBD. Multiple sclerosis has been repeatedly associated with IBD. Up to 50% of IBD present asymptomatic white matter lesions. Other central nervous system complications include a slowly progressive myelopathy, epidural and subdural spinal empyema secondary to fistulous extension from the rectum, seizures, and encephalopathy.
authors.affiliation: Neurology Service, Department of Neurosciences, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal. Electronic address: jmferro@fm.ul.pt.
authors.forename: José M
authors.initials: JM
authors.lastname: Ferro
authors.affiliation: Department of Neurology, Hospital da Luz, Lisbon, Portugal.
authors.forename: Sofia N
authors.initials: SN
authors.lastname: Oliveira
authors.affiliation: Department of Gastroenterology and Hepatology, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.
authors.forename: Luis
authors.initials: L
authors.lastname: Correia
mesh_terms: D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008279:Magnetic Resonance Imaging; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D015898:Tomography Scanners, X-Ray Computed
keywords: Crohn’s disease; Ulcerative colitis; anti-TNF-α; cerebral venous thrombosis; inflammatory bowel disease; polyneuropathy; stroke; white matter lesions