Objective: To explore an unusual cause of ataxia in a patient with known Celiac disease.

Background: Celiac disease is the established but not the only manifestation of Gluten sensitivity disorders. Gluten ataxia is a rare form of Gluten sensitivity disorder and a reversible cause of cerebellar ataxia (Khawaja et al. 2015). This can result from consuming gluten diet in patient with known or unknown gluten sensitivity disorders.

Method: A case study method was employed in this study. A 71 years old gentleman, admitted to Grantham District Hospital after he had a fall due to a recent onset ataxia. He was a known case of Coeliac disease and was not on gluten-free diet prior to his admission. Whilst inpatient, he developed chest infection which was refractory to broad-spectrum antibiotics. He was also noted to have oropharyngeal dysphagia and horizontal nystagmus in addition to ataxia,

Results: A nasogastric tube was inserted and he was given Gluten-free diet. His symptoms improved in few weeks and started eating normally. His chest infection resolved with simple antibiotics. His MRI brain showed generalised atrophy. Improvement in the neurological symptoms after gluten-free diet confirmed the diagnosis of Gluten Ataxia (Khawaja et al. 2015). On review of literature, Hadjivassiliou et al. (2014) have reported prevalence of gluten ataxia in 10-22% cases of established Coeliac disease. MRI brain does not necessarily show cerebellar atrophy in all the cases of Gluten Ataxia (Hadjivassiliou et al., 2005).

Conclusion: The diagnosis of Gluten ataxia should be considered in patients presenting with unexplained neurological symptoms in known or unknowns cases of Gluten sensitivity disorders.

References: 1. Briani C, Zara G, Alaedini A, et al. Neurological complications of coeliac disease and autoimmune mechanisms: a prospective study. J Neuroimmunol. 2008;195:171–75. 2. Hadjivassiliou M, Duker AP, Sanders DS. Gluten-related neurologic dysfunction. In Biller J, Ferro JM editors Handbook of Clinical Neurology. Neurologic Aspects of Systemic Disease Part II Vol 120 Elsevier press; 2014. pp.607-619. 3. Hadjivassiliou M, et al. Gluten sensitivity: from gut to brain. Lancet Neurol. 2010;9:318–30. 4. Khwaja, A. et al. Gluten Sensitivity – A Potentially Reversible Cause of Progressive Cerebellar Ataxia and Myoclonus – A Case Report. J Clin Diag Res 2015; 9 (11).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/think-of-gluten-ataxiaa-rare-but-potentially-reversible-cause-of-progressive-neurological-disorder/