Celiac disease and childhood stroke

Goodwin, Fiona C., Beattie, R. Mark, Millar, John and Kirkham, Fenella J. (2004) Celiac disease and childhood stroke. Pediatric Neurology, 31 (2), 139-142. (doi:10.1016/j.pediatrneurol.2004.02.014).

Abstract

Celiac disease is associated with a diversity of central nervous system manifestations although an association with stroke has not been documented. This case report describes a child who presented with a recurrent transient hemiplegia. Magnetic resonance imaging of the brain confirmed infarction; transcranial Doppler studies and magnetic resonance angiography were abnormal. Although there were virtually no gastrointestinal symptoms and the child was thriving, celiac disease serology was strongly positive and a duodenal biopsy confirmed the disease. Tissue transglutaminase is the major autoantigen in celiac disease and is thought to maintain vascular endothelial integrity. Antiendomysial immunoglobulin A antibodies, demonstrated to be the same autoantibody as antitransglutaminase, react with cerebral vasculature, suggesting an autoimmune mechanism for celiac disease associated vasculopathy. Because celiac disease is a potentially treatable cause of cerebral vasculopathy, serology - specifically antitissue transglutaminase antibodies - should be included in the evaluation for cryptogenic stroke in childhood, even in the absence of typical gut symptoms.

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Contributors

Author: Fenella J. Kirkham

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