Multiple Cerebral Infarction Associated with Cerebral Vasculitis in a Patient with Ulcerative Colitis

Abstract

A 40-year-old man was admitted to the hospital due to both a worsening of symptoms associated with ulcerative colitis (UC), which had been diagnosed 3 years previously, and limb paralysis. Colonoscopy revealed severe pancolitis-type UC. He was diagnosed with cerebral vasculitis with multiple white matter infarctions associated with the disease activity of UC by contrast-enhanced head magnetic resonance imaging. Mesalazine at 4,000 mg/day and prednisolone at 60 mg/day were started, and the prednisolone dosage was thereafter gradually reduced and switched to golimumab. He achieved a long-term remission from UC, and thereafter his neurological abnormalities improved significantly. He had no recurrence of cerebral infarction.

Keywords: cerebral infarction; cerebral vasculitis; ulcerative colitis.

Figure 1.

Abdominal computed tomography (CT) was performed upon admission. A CT scan revealed thickening of the mucosa from the transverse (a) colon to the sigmoid colon (b) due to ulcerative colitis (UC).

Figure 2.

Colonoscopy performed in day 8 from admission: a) transverse colon, b) descending colon, c) sigmoid colon, and d) rectum. The endoscopic findings revealed a rough intestinal mucosa with disappearance of the visible submucosal vascular pattern of the mucosa from the transverse colon to the rectum. Deep ulceration and crypt abscess were also identified.

Figure 3.

Head magnetic resonance imaging (MRI) revealed acute cerebral infarctions scattered in the left semioval center (a), bilateral corona radiata (b). Magnetic resonance angiography (c) did not show any occlusion or stenosis of the major cerebral arteries. Head contrast-enhanced MRI revealed several small round contrast effects in the bilateral deep white matter (d) and linear contrast effects in the meninges of the left temporal lobe (e). MRI susceptibility-weighted imaging revealed microbleeds in the bilateral deep white matter (f).

Figure 4.

The patient’s clinical course from recurrence of UC to remission.

Figure 5.

Head magnetic resonance imaging (MRI) of the left semioval center (a) and bilateral corona radiata (b), which was performed at 9 months after the onset of cerebral infarction. The high-intensity areas disappeared, and no new lesions were observed.