Neurological Disorders Associated with Gluten Sensitivity
Abstract:
Background: Gluten sensitivity and celiac disease are increasingly recognized as causes of extraintestinal manifes tations, including neurological disorders. Among these, gluten ataxia represents an important but often underdiag nosed condition in clinical practice.
Case Presentation: We report the case of a 56-year-old woman who presented with a two-month history of progres sive bilateral upper-limb tremor, followed by dizziness, gait instability, and whole-body tremor. Initial treatment with sulpiride led to worsening of symptoms. The patient also reported chronic diarrhea over several months. Neurolog ical examination revealed lateral gaze nystagmus and gait instability with a widened base, while cranial magnetic resonance imaging and electroencephalography were normal. Endoscopic duodenal biopsy demonstrated partial villous atrophy with increased intraepithelial lymphocytes (Marsh IIIa), consistent with celiac disease. Diagnosis: Based on clinical presentation, histological findings, and exclusion of alternative causes, a diagnosis of gluten-related cerebellar ataxia was established. Conclusion: This case highlights the importance of considering gluten sensitivity in patients presenting with un explained cerebellar ataxia, even in the absence of prominent gastrointestinal symptoms. Early recognition and initiation of a strict gluten-free diet may lead to clinical improvement or stabilization of neurological manifestations. Screening for celiac disease and gluten-related antibodies should be considered in the diagnostic evaluation of cer ebellar ataxia.
