CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders: Autoinflammatory Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1662213
Acute onset hemiparesis in a young man: do not miss Crohn's disease
Provisionally accepted
Virginia Iacobelli1
Simone Tagliabue1Beatrice Modello2Daniele Velardo3Elena Abati1
Fabio Triulzi2Giacomo Pietro Comi1,3Stefania Corti1,4*Delia Gagliardi3Mosè Parisi3- 1Department of Pathophysiology and Transplantation (DEPT), University of Milan, Milan, Italy
- 2Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- 3Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Centre, Department of Neuroscience and Mental Health, Milan, Italy
- 4Neuromuscular and Rare Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Centre, Department of Neuroscience and Mental Health, Milan, Italy
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Crohn's disease (CD) is a chronic inflammatory bowel disease that may include neurological complications, besides gastrointestinal manifestations. Although cerebrovascular complications are commonly reported, cerebral vasculitis remains an exceedingly rare occurrence and only a limited number of cases have been described.We present the case of a 35-year-old man with CD who presented with acute onset of right-sided hemiparesis, hemiataxia and paresthesias. Laboratory data showed an inflammatory profile. Contrast-enhanced brain magnetic resonance angiography (MRA) with vessel wall imaging well demonstrated focal areas of contrast enhancement in the perforating arteries and distal arterial branches of intracranial vessels, raising the suspicion of a vasculitic process. The patient was then started on high-dose steroid therapy with immediate improvement of the neurological condition. Follow-up brain MRA revealed a significant reduction of the focal contrastenhancing alterations.If not accurately identified and promptly treated, vasculitic processes may lead to significant disabilities in young patients and should be considered in the differential etiologies of juvenile stroke since symptoms can improve with immunosuppressive treatment. This case highlights the broad spectrum of possible etiologies to be considered in a young patient presenting with an acute onset neurological syndrome and provides a stepwise approach to developing a comprehensive differential diagnosis.
Keywords: Crohn's disease, inflammatory bowel disease, Cerebral vasculitis, Juvenile stroke, intracranial vessel wall imaging
Received: 08 Jul 2025; Accepted: 18 Aug 2025.
Copyright: © 2025 Iacobelli, Tagliabue, Modello, Velardo, Abati, Triulzi, Comi, Corti, Gagliardi and Parisi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Stefania Corti, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Milan, Italy
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