Food and Behaviour Research

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Rare Neurological Manifestation of Celiac Disease

Rani U, Imdad A, Beg M. (2015) Case Rep Gastroenterol. 2015 Jun 9; 9(2) 200-5. doi: 10.1159/000431170. 

Web URL: View this and related research via PubMed here. Free full text of this article is available online

Abstract:

Celiac disease (CD) is an immune-mediated disease characterized by permanent gastrointestinal tract sensitivity to gluten in genetically predisposed individuals. It has varied clinical manifestations, ranging from gastrointestinal to extraintestinal, including neurological, skin, reproductive and psychiatric symptoms, which makes its diagnosis difficult and challenging.

Known neurological manifestations of CD include epilepsy with or without occipital calcification, 
attention deficit hyperactivity disorder and ataxia, headache, neuropathies and behavior disorders.

We present the case of a 14-year-old female with headaches and blurred vision for 1 year; she was noted to have papilledema on ophthalmic examination with increased cerebrospinal fluid opening pressure on lumber puncture and was diagnosed as a case of pseudotumor cerebri (PTC).

Meanwhile her workup for chronic constipation revealed elevated tissue transglutaminase IgA and antiendomysial IgA antibodies. Upper gastrointestinal endoscopy with duodenal biopsy confirmed the diagnosis of CD.

The patient was started on a 
gluten-free diet, leading to resolution of not only gastrointestinal symptoms but also to almost complete resolution of symptoms of PTC. This report describes the correlation of CD and PTC as its neurological manifestation.

FAB RESEARCH COMMENT:

This case report illustrates the importance of clinical investigation of GI symptoms (in this case chronic constipation) when these co-occur with psychiatric symptoms.

It has long been known that coeliac disease, involving auto-immune reactions to gluten, can manifest in many different ways, including the causation of neurological and/or psychiatric symptoms in some patients, as in this case.

In addition, it is also well-established that gluten can in fact trigger mental symptoms in some people who do NOT have classic coeliac disease - a condition known as 'non-coeliac gluten sensitivity' (NCGS).

This too is therefore worthy of consideration by clinicians working with mental health patients. However, specialist dietary assessment and advice should always be recommended before excluding any major food groups (such as all gluten grains) from the diet.

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