Cerebral vasculitis mimicking migraine with aura in a patient with Crohn's disease.

INTRODUCTION

Whereas extraintestinal manifestations of inflammatory bowel disease in general are quite common, cerebral vasculitis is considered a very rare condition. We present a case of Crohn's disease-associated vasculitis mimicking migraine with aura.

CASE DESCRIPTION

A 28-year-old woman with Crohn's disease and known migraine with aura had suffered from daily migraine attacks with recurrent focal neurological deficits for 6 weeks. Cerebral magnetic resonance imaging showed multiple acute, subacute, and chronic ischemic lesions in different vascular territories. Magnetic resonance and computed tomography angiography demonstrated vessel changes consistent with cerebral vasculitis. Laboratory investigations revealed systemic inflammation and lymphomonocytic pleocytosis of cerebrospinal fluid, supporting the diagnosis of Crohn's disease-associated vasculitis. Symptoms and inflammatory parameters quickly normalized after high-dose prednisolone treatment. During immunosuppressive therapy, migraine recurred only once in 11 months.

DISCUSSION

Cerebral vasculitis is a very rare but severe complication in Crohn's disease and should be excluded in case of comorbidity with migraine with aura. In our patient, migraine with aura may have been the only symptom of cerebral vasculitis for several years.