Should we be ‘nervous’ about coeliac disease? Brain abnormalities in patients with coeliac disease referred for neurological opinion
- Stuart Currie1,
- Marios Hadjivassiliou2,
- Matthew JR Clark1,
- David S Sanders3,
- Iain D Wilkinson1,
- Paul D Griffiths1,
- Nigel Hoggard1
- 1Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
- 2Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
- 3Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
- Correspondence to Dr M Hadjivassiliou, Department of Neurology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK;
Contributors Study design: SC, MH and NH. Patient recruitment and data collection: SC, MH, DS and NH. Data analysis and interpretation: SC, MC, IW and NH. Manuscript drafting: SC, MH, PDG, DS, IG and NH. Manuscript revision: SC, MH, NH.
- Received 21 May 2012
- Revised 27 July 2012
- Accepted 31 July 2012
- Published Online First 20 August 2012
Objectives To examine the extent of brain abnormality in patients with coeliac disease referred for neurological opinion and evaluate MR imaging sequences as biomarkers for neurological dysfunction, given the lack of readily available serological markers of neurological disease in this cohort.
Methods Retrospective examination of a consecutive cohort of patients (n=33, mean age=44±13 years (range 19–64)) with biopsy proven coeliac disease referred for neurological opinion. Patients were divided into subgroups based on their primary neurological complaint (balance disturbance, headache and sensory loss). 3T MR was used to evaluate differences in brain grey matter density, cerebellar volume, cerebellar neurochemistry and white matter abnormalities (WMAs) between subjects and controls.
Results Cerebellar volume was significantly less in the patient group than in controls (6.9±0.7% vs 7.4±0.9% of total intracranial volume, p<0.05). Significantly less grey matter density was found in multiple brain regions, both above and below the tentorium cerebelli, than in controls (p<0.05). 12 (36%) patients demonstrated WMAs unexpected for the patient's age, with the highest incidence occurring in the headache subgroup. This subgroup averaged almost twice the number of WMAs per MR imaging than the subgroup with balance disturbance and six times more than the subgroup with sensory loss.
Conclusion Patients with established coeliac disease referred for neurological opinion show significant brain abnormality on MR imaging. MR imaging may provide valuable biomarkers of disease in this patient cohort.
- Cerebellar ataxia
- cerebellar degeneration
- b12 deficiency
- cerebellar degeneration
- cerebellar disease
Competing interests None.
Ethics approval Ethics approval was provided by National Research Ethics Service Committee Yorkshire and the Humber, Leeds East.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Unpublished data is kept anonymised and secure within the Academic Unit of Radiology, Royal Hallamshire Hospital, Sheffield, UK. It is available to members of the research team.