克罗恩病合并脑梗死1例及文献复习

Cerebral Infarction as a Complication of Crohn’s Disease:A Case Report and Literature Review

目的:分析克罗恩病合并脑梗死的临床特点。方法:报道1例临床、影像学和病理确诊为克罗恩病合并脑梗死的患者,并复习文献予以分析。结果:克罗恩病患者先有腹泻、乏力、食意减退,并发口腔溃疡、皮疹,约20 d出现左侧肢体偏瘫、构音障碍。MRI提示右侧大脑半球额颞顶叶梗死灶;病理提示结肠黏膜急慢性炎症;红细胞沉降率增快,凝血因子Ⅴ、Ⅷ和纤维蛋白原活性增加。经甲泼尼龙治疗后肠道及神经系统症状均改善。结论:克罗恩病合并脑梗死少见,病因可能与高凝状态及血管炎相关,目前主张应用美沙拉嗪和肾上腺皮质激素治疗。

Aim： One case with Crohn’s disease complicated with cerebral infarction was reported.Methods： A 38-year old man with Crohn’s disease complicated with cerebral infarction was presented.He was diagnosed by clinical manifestation,imageology and pathology.Related literature was also reviewed.Results： The patient with Crohn’s disease manifested diarrhea,fatigue,anorexia combined with canker sore and skin eruption.After 20 days,paralysis on his left side and dysarthria were observed.Focus of infarction in the frontal,parietal and temporal lobe of right side brain were shown in MRI.And pathological examination showed the infiltration of inflammatory cells in colonic mucous tissue.The laboratory investigations revealed increased levels of ESR,factor Ⅴ,factor Ⅷ and fibrinogen.The initial patient’s intestinal and neurological symptoms required modification of steroid treatment.Conclusion： The patients of Crohn’s disease rarely involve cerebrovascular events,which may be associated with hypercoagulability or arteritis.5-aminosalicylic acid and steroid treatment are advocated.