A 3-year-old girl who presented with recurrent episodes of transient hemiplegia and cerebral infarction was diagnosed with asymptomatic celiac disease in a report from Southampton General Hospital, UK. MRI, transcranial Doppler, and MR angiography were abnormal. Tests for celiac disease were positive, despite absence of gastrointestinal symptoms and normal growth and development. Antiendomysial immunoglobulin A antibodies were strongly positive, antitransglutaminase antibodies grossly elevated at over 200 U/mL (normal 1-15 U/mL), and duodenal biopsy confirmed the diagnosis. After a gluten-free diet, aspirin, and folate supplements, energy level and mood improved (in retrospect the child was considered lethargic and irritable before treatment), and neurodevelopment was normal at 1-year follow-up. The significant asymmetry between right and left middle cerebral artery velocities on Doppler studies had persisted. [1]

COMMENT. Stroke has not previously been reported as a complication of celiac disease in childhood. In a recent study of neurologic complications of childhood celiac disease that involved 111 patients (reviewed in Ped Neur Briefs June 2004; 18:46) [2], neurologic disorders were diagnosed in 51% (cf 20% controls) and included chronic migraine headache, developmental delay, hypotonia, learning disabilities, ADHD, and epilepsy with occipital calcifications, but not stroke. As with stroke, the occipital lobe seizures may be associated with asymptomatic celiac disease.