A case of myopathy with ulcerative colitis

A 41-year-old woman was admitted to a local hospital because of bloody diarrhea and diagnosed as having ulcerative colitis (UC). Despite prednisolone of 40 mg/day administration, her symptoms aggravated rapidly and she developed muscle weakness of lower limbs two weeks after steroid administration. On admission, she was bed-ridden and could not lift her knees and arms from bed. The serum CK level was increased slightly and total protein decreased markedly. She had moderate liver dysfunction, mild hyperthyroidism, mild glucose intolerance, and some results suggestive of immuno-deficiency including positive cold agglutinin and microsome tests, and positive antinuclear antibody. Her muscle biopsy showed both type 1 and 2 fiber atrophy and focal myofibrillar degeneration with autophagic phenomenon. There were a few fibers with nemaline bodies probably formed from marked degeneration of myofibrils. Although she had been on prednisolone for 2 weeks, the degenerative muscle pathology differed from that of steroid myopathy in which type 2 fiber atrophy is one of characteristic findings. Some additional factors including marked malnutrition, possible immuno-deficiency and hyperthyroidism should be considered for the pathogenesis of this particular myopathic changes. Since her general condition and muscle weakness gradually improved postoperatively, UC itself might have played an important role in inducing muscle symptoms.     

AIDS with acute cerebral infarct: a case report

A 38 year-old male presented with an acute onset of left hemiplegia. Brain magnetic resonance imaging (MRI) revealed a bright lesion by diffusion-weighted imaging with low apparent diffusion coefficient value in the right subcortical region, a finding compatible with an acute cerebral infarct. An old infarct was also noted in the same imaging. Both enzyme-linked immunosorbent assay and Western blot method were positive for human immunodeficiency virus infection. The white blood cell count was 2930 cells / mm3, and the subpopulation study for lymphocyte revealed a decreased cluster of differentiation 4+ count of 149 cells/mm3. Studies for prothrombotic states showed decreased protein S and increased anticardiolipin antibodies. We concluded that this was a case of acquired immunodeficiency syndrome (AIDS) with acute and old cerebral infarcts. This patient might be the first reported case in Taiwan. AIDS might be related with stroke in young patients, a condition probably under-recognized in Taiwan.     

Conditioned relaxation in a case of ulcerative colitis

A case of ulcerative colitis was treated by conditioned relaxation of the abdominal area. In the course of three months symptoms subsided and had not recurred after a period of one year.     

Anticoagulation therapy in cerebral sinovenous thrombosis and ulcerative colitis in children

We describe four pediatric patients with ulcerative colitis and cerebral sinovenous thrombosis and review the pediatric and adult literature on the treatment of sinovenous thrombosis. All of our patients had headache as the initial complaint with onset during an ulcerative colitis flare. Evaluation for hypercoagulable states revealed heterozygosity for prothrombin gene mutation and increased homocysteine level in one patient and mild elevation of anticardiolipin antibodies in two patients. Treatment in the acute period included thrombolysis, heparin, and low-molecular-weight heparin. Chronic therapy included warfarin, low-molecular-weight heparin, and aspirin. Peripheral vein thrombosis occurred in two patients while not on antiplatelet or anticoagulation therapy. Neurologic outcome was positive in this series without complications of therapy, suggesting that aggressive therapy should be considered. Although anticoagulation therapy of sinovenous thrombosis is controversial, particularly in the context of intestinal hemorrhage, it can be beneficial given the possibility of an ongoing hypercoagulable state.     

Pemphigoid and cerebral infarct. Syntropy of 2 diseases? Case report

We report on two patients who suffered from bullous pemphigoid and developed cerebral infarctions during the course of this autoimmune dermatosis. The first patient who had a bullous dermatosis for three weeks presented with a sudden paresis of her right arm. She improved under steroid therapy and developed a left sided hemiparesis after steroids were reduced for diagnostic purposes. The second patient developed signs of brain stem infarction during the course of full-blown bullous pemphigoid. Neither patient had known risk factors, signs of atherosclerosis or cardiac embolism. Both patients improved with steroids and azathioprine.     

Combined treatment of cerebral aneurysm and angioma. A case report

The paper presents a case of co-existent cerebral aneurysm and angioma, as well as the treatment method used. Although in the authors' Center over 600 patients were submitted to aneurysm surgery and in about 250 cases endovascular procedures were performed during the past decade, it is for the first time that the co-existence of both aneurysm and angioma has been found. Successive stages of the diagnostic process, therapeutic procedures in the order of their application, as well as the treatment outcome are discussed. "Combined" treatment including both microsurgery and endovascular techniques can be regarded as effective in the treatment of mixed vascular malformations in the brain, making a full recovery possible.     

Perineuritis and ulcerative colitis

We describe the association of chronic polyneuropathy with ulcerative colitis. Electrophysiologic studies disclosed a severe neuropathy with both axonal and demyelinating features. The CSF protein content was 875 mg/dl. Sural nerve biopsy revealed perineuritis. Peripheral neuropathy with perineuritis may be an immunologically mediated extraintestinal manifestation of ulcerative colitis.     

Strokes and ulcerative colitis

One adolescent and two young adults had ulcerative colitis and cerebral thrombosis. All survived with neurologic deficit. These patients had no other predisposing factor for cerebrovascular disease. Systemic arterial and venous thromboembolic complications occur often in ulcerative colitis, but stroke is uncommon. Abnormalities in the early stages of clotting may be responsible, and the risk of thromboembolic phenomena in young patients seems to increase with exacerbations of this form of chronic inflammatory bowel disease, and possibly with regional enteritis as well.     

Adrenoleukodystrophy associated with vitiligo and ulcerative colitis.

Adrenoleukodystrophy (ALD) is an X-linked inherited disorder of lipid metabolism usually presenting in childhood or early adolescence. It is a progressive disease with symptoms of adrenal insufficiency and central nervous system demyelination. The pathology results from the accumulation of very long-chain fatty acids and an inflammatory reaction in the brain white matter. We report a case of ALD associated with adrenal insufficiency and two autoimmune diseases: vitiligo and ulcerative colitis.     

Hemichorea, moya-moya, and ulcerative colitis.

This is a case report linking chorea, colitis, and moya-moya. The clear involvement in the vasculopathy of the basal ganglia offers an obvious substrate for the movement disorder.     

Hemorrhagic infarct induced by arterial hypertension in cat brain following middle cerebral artery occlusion

The purpose of this experiment was to determine whether an acute rise in brain perfusion pressure causes hemorrhagic transformation of an infarct without a reopening of the occluded artery. We raised the blood pressure of 22 cats by aortic obstruction 5-24 hours after transorbital middle cerebral artery clipping; hemorrhagic infarcts were induced in 11. Mean arterial blood pressure increased by 57.2 +/- 16.9 mm Hg (mean +/- SD) in the 11 cats with hemorrhagic infarcts and by 40.4 +/- 16.9 mm Hg in the 11 remaining cats with pale brain infarcts (p less than 0.05). Induction of hypertension increased regional cerebral blood flow in the ischemic cortical gray matter more in three cats with hemorrhagic infarcts than in seven with pale infarcts. Our results demonstrate that hemorrhagic transformation of an infarct can be induced by a rapid increase in perfusion pressure to brain tissue already exposed to focal ischemia. We also suggest that the restoration of blood flow through leptomeningeal collaterals plays an important role in the pathogenesis of hemorrhagic infarction in cases without reopening of occluded arteries.     

Severe neurological complications of ulcerative colitis.

A 37 year old man presented with a 15 year history of ulcerative colitis. On examination he had weakness of the right arm, slurred speech and progressive confusion, followed by a rapid deterioration of consciousness and motor functions resulting in coma, tetraparesis and bilateral Babinski responses. Magnetic resonance imaging of the brain and spinal cord revealed multiple hyper- and hypointense white matter lesions. Clinical symptoms, history and neuroradiological findings led to the diagnosis of an ulcerative colitis-associated CNS disorder. An autoimmune vasculitic process may have played an important pathophysiological role, considering the vasculitic changes observed by skin biopsy as well as the rapid clinical improvement following immunosuppressive therapy with corticosteroids and azathioprine. During a follow up period of more than one year we observed continuous and complete recovery of neurologic symptoms.     

Hemorrhagic unilateral moyamoya: report of one case

A 29 year old woman presented with an intracerebral hemorrhage. Angiographic findings were consistent with unilateral moyamoya. The patient was managed non-surgically and discharged with the indication of periodical followup angiography. Moyamoya is a rare entity that must be considered in the differential diagnosis of ischemic or hemorrhagic cerebrovascular events. At present, the natural history of unilateral moyamoya is not well established in relation to the progression to a bilateral form and to rebleeding risk. Periodical follow-up angiography (conventional or MRI) seems a reasonable management strategy.