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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Nov 15, 2015; 6(4): 124-130
Published online Nov 15, 2015. doi: 10.4291/wjgp.v6.i4.124
Structural brain lesions in inflammatory bowel disease
Can Dolapcioglu, Hatice Dolapcioglu
Can Dolapcioglu, Department of Gastroenterology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, 34890 Istanbul, Turkey
Hatice Dolapcioglu, Department of Pathology, Fatih Sultan Mehmet Research and Training Hospital, 34752 Istanbul, Turkey
Author contributions: Both authors contributed to the conception and design of this work, to the acquisition and interpretation of the data, and to the drafting/writing of the manuscript.
Conflict-of-interest statement: The authors do not report any conflict of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Can Dolapcioglu, Department of Gastroenterology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Şemsi Denizer Cad. E-5 Karayolu Cevizli Mevkii Kartal, 34890 Istanbul, Turkey. candolapci@hotmail.com
Telephone: +90-532-2613919 Fax: +90-216-4188752
Received: April 20, 2015
Peer-review started: April 21, 2015
First decision: May 18, 2015
Revised: July 7, 2015
Accepted: August 30, 2015
Article in press: September 7, 2015
Published online: November 15, 2015
Processing time: 210 Days and 15.6 Hours
Abstract

Central nervous system (CNS) complications or manifestations of inflammatory bowel disease deserve particular attention because symptomatic conditions can require early diagnosis and treatment, whereas unexplained manifestations might be linked with pathogenic mechanisms. This review focuses on both symptomatic and asymptomatic brain lesions detectable on imaging studies, as well as their frequency and potential mechanisms. A direct causal relationship between inflammatory bowel disease (IBD) and asymptomatic structural brain changes has not been demonstrated, but several possible explanations, including vasculitis, thromboembolism and malnutrition, have been proposed. IBD is associated with a tendency for thromboembolisms; therefore, cerebrovascular thromboembolism represents the most frequent and grave CNS complication. Vasculitis, demyelinating conditions and CNS infections are among the other CNS manifestations of the disease. Biological agents also represent a risk factor, particularly for demyelination. Identification of the nature and potential mechanisms of brain lesions detectable on imaging studies would shed further light on the disease process and could improve patient care through early diagnosis and treatment.

Keywords: Inflammatory bowel disease; Ulcerative colitis; Crohn’s disease; Structural lesions; Magnetic resonance imaging; Brain lesions

Core tip: Central nervous system complications or manifestations of inflammatory bowel disease deserve particular attention because symptomatic conditions can require early diagnosis and treatment, whereas unexplained manifestations might be linked to pathogenic mechanisms. This review focuses on both symptomatic and asymptomatic brain lesions detectable on imaging studies, as well as their frequency and potential mechanisms. A direct causal relationship between inflammatory bowel disease and asymptomatic structural brain changes has not been demonstrated, but several possible explanations, including vasculitis, thromboembolism and malnutrition, have been proposed. Identification of the nature and potential mechanisms of brain lesions on imaging studies would improve patient care through early diagnosis and treatment.