Department of Emergency Medicine, Pusan National University Yangsan Hospital, South Korea.
Department of Emergency Medicine, Pusan National University Yangsan Hospital, South Korea.
Am J Emerg Med. 2018 Apr;36(4):733.e3-733.e5. doi: 10.1016/j.ajem.2018.01.006. Epub 2018 Jan 4.
Ulcerative colitis (UC) is a chronic and debilitating disorder, characterized by inflammation of the colonic mucosa. UC can be considered a systemic disorder but UC-related manifestations in the central nervous system (CNS) are quite rare. A 29-year-old man was admitted to the emergency department with repeated generalized tonic-clonic (GTC) type seizures. Based on brain CT, brain metastasis or hemorrhagic infarct was suspected. Diffusion-weighted image of brain MRI showed high signal in the left thalamus and heterogenous enhancement in the right parietal and left frontal lobes. This image indicated a cerebral infarct, but could not completely rule out cerebral metastasis and vasculitis, or any other pathology. However, the brain biopsy revealed multiple thromboemboli with acute inflammation and necrosis. Thus, the patient was diagnosed with multiple cerebral infarcts with cerebral vasculitis, occurring as a complication of UC. In conclusion, CNS manifestations of UC are rare. However, clinicians should consider uncommon diagnoses like vasculitis and thromboembolism in patients with UC presenting with seizures.
溃疡性结肠炎（UC）是一种慢性且使人虚弱的疾病，其特征为结肠黏膜炎症。UC 可被视为一种全身性疾病，但 UC 相关的中枢神经系统（CNS）表现相当罕见。一名 29 岁男性因反复全身性强直阵挛（GTC）型癫痫发作而被收入急诊部。基于脑 CT，疑似脑转移或出血性梗死。脑 MRI 的弥散加权图像显示左丘脑高信号和右顶叶及左额叶不均匀强化。该图像提示脑梗死，但不能完全排除脑转移、血管炎或任何其他病变。然而，脑活检显示多发性伴有急性炎症和坏死的血栓栓塞。因此，该患者被诊断为 UC 并发的多发性脑梗死伴脑血管炎。总之，UC 的 CNS 表现罕见。然而，对于出现癫痫发作的 UC 患者，临床医生应考虑血管炎和血栓栓塞等不常见的诊断。
