• Ads by Google:
     




    Get email alerts Celiac.com E-Newsletter

    Ads by Google:



       Get email alertsCeliac.com E-Newsletter

  • Announcements

    • admin

      Frequently Asked Questions About Celiac Disease   09/30/2015

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to FREE Celiac.com email alerts What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease? - list blood tests, endo with biopsy, genetic test and enterolab (not diagnostic) Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet Free recipes: Gluten-Free Recipes Where can I buy gluten-free stuff? Support this site by shopping at The Celiac.com Store.

A Question For The Mds
0

6 posts in this topic

Ads by Google:
Ads by Google:


I decided to post just the symptoms. I don't think that would be a copyright infringement.

A 58-year-old right-handed woman with type 1 diabetes was admitted to the hospital because of a 2-week history of increasing fatigue and word-finding difficulties and a 2-day history of right-arm weakness.

She had been in her usual state of health until 3 years before admission, when an episode of word-finding difficulty occurred, associated with headache and mild right-sided facial weakness. She was admitted to a local hospital, where computed tomography (CT) of the head revealed no abnormalities. Magnetic resonance imaging (MRI) revealed a punctate subcortical lesion in the left parietal white matter; magnetic resonance angiography (MRA) revealed no extracranial or intracranial stenosis. The symptoms resolved spontaneously within a few hours. Anticoagulation therapy with heparin followed by warfarin was begun, and she was discharged on the third hospital day. A 24-hour Holter monitor showed no arrhythmia. Several similar episodes occurred over the next 5 months, accompanied by weakness in the right arm and leg, which again resolved in a few hours. Repeated MRI and CT of the head, electrocardiography, and 48-hour cardiac monitoring showed no new abnormalities.

Two years before admission, the patient saw a neurologist at this hospital because of continuing episodes of confusion, word-finding difficulty, right-sided weakness, and fatigue, often accompanied by headaches with photophobia, nausea, and vomiting. Right-sided headaches had occurred intermittently for the past 5 years, preceded by flashes of light in the periphery of her visual fields. Since the first episode of word-finding difficulty, the headaches had been occasionally accompanied by tingling in the right fingers and forearm. She reported clumsiness of her right hand and difficulty with attention, calculation, and memory. Neurologic examination at that time showed diminished peripheral vision bilaterally, mild right ptosis, diminished sensation to pinprick and to light touch on the right side of the face, and a flattened right nasolabial fold. Motor strength was 4/5 in the hands and feet bilaterally and 5/5 elsewhere; deep-tendon reflexes were 1/4 distally and 2/4 proximally. There was no Babinski's sign. Warfarin was discontinued, and aspirin therapy was initiated, after which the patient was free of symptoms through a 1-month follow-up.

Eighteen months before admission, another episode of forgetfulness, word-finding difficulty, and right-sided weakness occurred. MRI showed a 1-cm2 area of increased signal on T2-weighted images of the periventricular white matter of the left occipital lobe, as well as nonspecific changes in periventricular white matter. One year before admission, the patient was admitted to her local hospital because of another strokelike episode. MRI showed areas of hyperintensity on T2-weighted images of the left corona radiata and of the splenium of the corpus callosum, which did not enhance after the administration of contrast material. On lumbar puncture, the cerebrospinal fluid was found to have normal serum chemistry and cell counts; a test for cryptococcal antigen was negative, and one oligoclonal band was detected. Hypercoagulability testing was negative. Aspirin and extended-release dipyridamole were begun.

Five months before admission, the woman was again seen by a neurologist at this hospital. Findings on neurologic examination were unchanged. Repeated MRI showed on T2-weighted images patchy areas of hyperintensity involving the periventricular white matter and the pons, with more prominent lesions in the left corona radiata and corpus callosum. Routine serum chemistry testing, tests for antinuclear antibodies and Lyme antibody, and vitamin B12 levels were normal.

Three months before admission, headache and word-finding difficulties recurred, and the patient was admitted to this hospital. Repeated MRI showed a new area of hyperintensity on T2-weighted images in the posterior left corona radiata. Positron-emission tomography with 18F-fluorodeoxyglucose showed diffuse hypometabolism in the cerebral cortex. Magnetic resonance spectroscopy showed no abnormalities. Lumbar puncture was performed to collect cerebrospinal-fluid specimens, for which serum chemistry, cell counts, cultures, and electrophoresis were normal. Tests for anti-Ro and anti-La antibodies, for IgG antibodies against hepatitis C, for hypercoagulability, and for methylmalonic acid were negative, as were serum and urine toxicology screens and genetic tests for the NOTCH3 mutation and for mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS). Skin and muscle biopsies were performed; pathological examination showed thickening of the basal lamina around small blood vessels, but a specific diagnosis was not made. Weekly injections of interferon beta-1a were begun. The patient was discharged to a rehabilitation facility on the 10th hospital day and went home 3 weeks later.

Two months later, she again had fatigue. During a 2-week period, she thought that her right-sided weakness had progressed, and on the day of admission, she had another episode of word-finding difficulty, headache, and weakness in both hands. She came to the emergency department of this hospital. While there, she became agitated, mute, and unable to follow commands. In response to noxious stimuli, she grimaced and withdrew her right arm but not her right leg. The results of CT and CT angiography were normal. She was admitted to the hospital.

Diabetes had been diagnosed 30 years earlier, during pregnancy. Glycemic control had been difficult to achieve. The patient had been treated at various times with multiple daily insulin injections and insulin-pump therapy, and on admission she was receiving a basal bolus regimen of insulin glargine, 18 units at night, and insulin lispro before meals according to a sliding scale. Her median glycated hemoglobin level over the previous 4 years was 9.1% and had ranged from a low of 6.8% to a high of 11.2%. Selected laboratory-test values are shown in Table 1. Systemic complications of diabetes included autonomic neuropathy with orthostatic hypotension and severe gastroparesis, peripheral neuropathy, nephropathy, and retinopathy. She had hypertension, coronary artery disease with a history of a silent myocardial infarction, congestive heart failure, and intermittent atrial fibrillation. A diagnosis of hypothyroidism had been made 35 years earlier. Other medical problems included depression, hepatitis B, shoulder and hip bursitis, and a duodenal ulcer.

0

Share this post


Link to post
Share on other sites

I saw this in my NEJM newsletter I get and even with just the 100 word abstract, it screamed out celiac to me!

Karen

0

Share this post


Link to post
Share on other sites

I don't think it screams celiac at all. I'm not saying that it couldn't be, but it really isn't all that similar to the pattern that is common (not even most common) for celiac. And this is a reason it's hard to diagnose - the pattern is very disperse. There are a couple of things that, once other options are exhausted, say "yeah, test for that too", but no, not top of the list. And *definitely* not a first presentation.

But I'm no doctor.

0

Share this post


Link to post
Share on other sites

Yes. I would screen her for Celiac. But that doesn't mean that's her main or only problem. Long-term Type 1 diabetes damages the brain and nerves, and she also has advanced heart disease. She sounds overall in rough shape, and her known problems could account for some her symptoms. Her A1c was *horrible*. She might also be developing MS or some form of autoimmune vasculitis. Could be Celiac, but could also be more than that or something else.

0

Share this post


Link to post
Share on other sites
Ads by Google:


I found it curious that it wasn't even part of the differential...

0

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
0

  • Forum Statistics

    • Total Topics
      106,403
    • Total Posts
      930,360
  • Member Statistics

    • Total Members
      63,825
    • Most Online
      3,093

    Newest Member
    Hchapman95
    Joined
  • Popular Now

  • Topics

  • Posts

    • Hi Could a mod please move this post:   and my reply below to a new thread when they get a chance? Thanks! Matt
    • Hello and welcome Firstly, don't worry about it but for ease your post (and hopefully my reply) will probably be moved to its own thread. That will make it easier for others to see it and reply and also help Galaxy's own thread here on track and making sense.  The antibodies that the celiac tests look for can drop very quickly, so... maybe? Celiac is difficult to test for, there are different tests and sometimes someone doesnt test on one but does on the other. If you can get a copy of the tests and post it here the community may be able to help explain the results.  It may have shown damage to the villi, the little tendrils in your intestine that help you extract nutrients from your food. Celiac is one, but not the only, way in which they can get damaged leading to a vast number of potential symptoms and further making diagnosis a tricky proposition. Definitely, there's a connection. Here's a page that explains it in detail: https://stomachachefree.wordpress.com/2012/03/21/liver-disease-in-celiacs/ Fantastic  It sounds as if your doctors were happy to diagnose you on the basis of the endoscopy? It may be then that you've found your answer. I hope so, you've clearly had a rotten and very scary time.  I'm sure with the positive reaction to the diet you want to go on and get healthy, but I would only add that you should discuss this with your doctors, because they may want to exclude other potential causes if they've not confirmed celiac at this point. Check out the advice for newly diagnosed here: To your family I'd simply say that celiac is a disease of the autoimmune system, the part of our body that fights diseases and keeps us safe. In celiac people the autoimmune system see's the gluten protein found in wheat, barley, or rye grains as a threat to the system and it produces antibodies to attack it and in doing so attacks it's own body as well. It's genetic in component so close family members should consider a test if they have any of the many symptoms. There's roughly 1 person in 100 with celiac but most of them don't know it and are risking getting or staying sick by not finding out.  There's further info for them and you here: https://www.celiac.com/gluten-free/announcement/3-frequently-asked-questions-about-celiac-disease/ I'm going to ask a mod to move your post and my reply to a new thread, but wanted to give you an answer first The good news is you've found a great site and there will be lots of support for you here. You've also got 'lucky' in that if you're going to have an autoimmune condition, celiac is a good one  Most react really well to the gluten free diet and you will hopefully have much more healing to come! Best wishes Matt
    • Please share what was so difficult about starting your account.
    • I'm new here so please forgive me if I'm in the wrong forum. But I could use some clarity and input.. So I'll try to make my story brief as possible😀 So about 8 months ago I began itching uncontrollably and after going to the Dr for labs she found my liver enzymes were 5x what they should be and was referred to a gastro Dr.  Gastrointestinal Dr ran multiple scans, blood work over the next 2 months and referred me to teaching hospital with a " tumor board" apparently I had a mass within my bile ducts that was blocking bile from liver. Was given a grim diagnosis of rare cancer and told would be dead within the year. Then had an endoscopy done to get tissue of the mass and for some reason it had partially resolved and was no longer blocking bile duct. At this point they could not find and cancerous cells. So fast forward 3 months I'm still in pain and had another endoscopy and the biopsy taken showed high possibility of celiacs.  The blood work was negative for celiac but after the grim cancerous diagnosis I had been unable to eat for 2 weeks or so and so I'm not sure if that would have skewed the labs?. How could the biopsy show high possibility of celiac?  And had anyone heard of celiac causing inflammation in the bile ducts?  I have been gluten-free for 6 weeks and have been feeling remarkably better pain in the upper right quadrant is less, and migraines ( I have had for my whole life) have lessened.  So all this to say I don't understand celiacs and how to explain it to family. Or how all of a sudden this happens. Ask if anyone can shed any insight I would appreciate it. Blessings   
    • Thank you for taking the time for sharing that info. Don't we have the best disease ever! There's got to be a better way to cut down the scarring. Yes, I've scratched till it bleed. Can't help it. It's like having a bunch of mosquito bites. Yes, only gluten free now. Still have bursts, so probably am being exposed to gluten. Will need to stop dapsone soon. Good luck with your situation.
  • Upcoming Events