title: Histologically confirmed case of cerebral vasculitis associated with Crohn's disease--a case report.
abstract: BACKGROUND
  Extraintestinal manifestations in Crohn's disease (CD) are frequent and well recognized. However, neurological involvement secondary to CD is rare, and there have been few histologically confirmed cases of cerebral vasculitis secondary to CD.
  
  
  METHODS
  A 58-year-old left-handed man with a history of refractory CD who had fever of over 38 °C, progression of CD symptoms, and Gerstmann's syndrome consulted our hospital. Laboratory data showed elevation of C-reactive protein (CRP) and hypoproteinemia. T2-weighted magnetic resonance imaging (MRI) revealed a right parietal high-intensity lesion. Catheter angiography showed segmental multiple narrowing and occlusion in the distal part of the middle cerebral artery and anterior cerebral artery. Angiography also revealed multiple venous occlusions in the affected parietal area. To confirm the diagnosis, the patient underwent open biopsy, and histological examination revealed cerebral vasculitis. The patient was then started on high-dose prednisolone (60 mg/day) in addition to his previous therapy, which included mesalazine, adalimumab, and azathioprine. CRP elevation, hypoproteinemia, and gastrointestinal symptoms immediately improved after starting this treatment. Neurological status improved simultaneously with CD symptom improvement, and follow-up brain MRI revealed a reduction in the size of the right parietal lobe lesion. He returned to normal status and was discharged from our hospital 5 weeks after admission.
  
  
  CONCLUSIONS
  This is an important case of histologically confirmed cerebral vasculitis associated with CD. The clinical course of our case clearly illustrates the relevance of the occurrence of cerebral vasculitis and the exacerbation of CD.
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Medical Center, 1-40 Maeda 1-12, Teine-Ku, Sapporo, 006-8555, Japan. m.gekka@live.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Gekka
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Medical Center, 1-40 Maeda 1-12, Teine-Ku, Sapporo, 006-8555, Japan. taku-s@yk9.so-net.ne.jp.
authors.forename: Taku
authors.initials: T
authors.lastname: Sugiyama
authors.affiliation: Center for Gastroenterology, Teine Keijinkai Medical Center, 1-40 Maeda 1-12, Teine-Ku, Sapporo, 006-8555, Japan. nomura@tkeijinkai.gr.jp.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nomura
authors.affiliation: Department of Translational Pathology, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan. y_kato@med.hokudai.ac.jp.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Translational Pathology, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan. nisihara@patho2.med.hokudai.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishihara
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Medical Center, 1-40 Maeda 1-12, Teine-Ku, Sapporo, 006-8555, Japan. asaoka@tkeijinkai.gr.jp.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Asaoka
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001379:Azathioprine / Q000008:administration & dosage; D001706:Biopsy; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D018450:Disease Progression; D005862:Gerstmann Syndrome / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D020293:Vasculitis, Central Nervous System / Q000150:complications* / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine; D011239:Prednisolone; D000068879:Adalimumab; D001379:Azathioprine