101
|
Yin H, Song Y, Zheng M, Han J, Tang J. Behcet's Disease With Cerebral Artery Infarction Caused by Cerebral Arteritis as an Early Symptom Only With Elevated Interleukin-8. Front Neurol 2019; 10:1102. [PMID: 31695669 PMCID: PMC6817676 DOI: 10.3389/fneur.2019.01102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/01/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Behcet's disease (BD) is multi-systemic vasculitis, which generally is repeated oral and genital ulcerations as well as ocular and skin lesions. Today, the pathogenesis of BD remains mostly unknown. It is also suggested that the disease is probably related to autoinflammatory and autoimmune disorders, and innate immunity damages were perceived as key in its pathologic process. Only 5% of BD patients have neurological involvement, and it usually occurs in 4–6 years after the initial symptoms. Early onset of neurological impairment makes it difficult to diagnose and treat definitely. Case Presentation: A 38-year-old man was admitted to our hospital with numbness and weakness of the left extremities. Diffusion magnetic resonance imaging (MRI) revealed focal infarction in the posterior limb of the internal capsule. Skin pathology suggested small vessel vasculitis, and high-resolution MRI revealed intracranial arteritis. The patient had a negative skin pathery test and then developed a scar at the venous puncture site at the early stage of disease. Laboratory examination showed that interleukin 8 (IL-8) increased. The patient was treated with an immunosuppressive agent including mycophenolate mofetil, hydroxychloroquine, and colchicine. All symptoms were alleviated after half a year's treatment. There was neither stroke nor recurrence of oral ulcer thereafter. Conclusion: This case demonstrates that neurological involvement might be an early symptom of BD. IL-8 could act as a novel target for the treatment of BD theoretically and probably play a key role in disease recovery.
Collapse
Affiliation(s)
- Hao Yin
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yun Song
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Meimei Zheng
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Ju Han
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jiyou Tang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| |
Collapse
|
102
|
Ishikawa H, Shindo A, Ii Y, Kishida D, Niwa A, Nishiguchi Y, Matsuura K, Kato N, Mizutani A, Tachibana K, Hirata Y, Matsuyama H, Ogawa-Ito A, Taniguchi A, Tomimoto H. MEFV gene mutations in neuro-Behçet's disease and neuro-Sweet disease. Ann Clin Transl Neurol 2019; 6:2595-2600. [PMID: 31682063 PMCID: PMC6917328 DOI: 10.1002/acn3.50937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/28/2019] [Accepted: 10/14/2019] [Indexed: 01/06/2023] Open
Abstract
Mediterranean fever (MEFV) gene mutations are associated with familial Mediterranean fever (FMF). Recent studies have suggested that MEFV gene mutations may act as disease modifiers in neuro‐Behçet's (NBD) disease and neuro‐Sweet disease (NSD). We investigated MEFV genes and clinical features in 17 patients with NBD or NSD. MEFV gene mutations were frequently observed (70.6%). Headaches and exertional leg pain were associated with MEFV gene mutations (P < 0.05). Moreover, higher frequency of white matter lesions without sites predilection (P < 0.05) and non‐parenchymal lesions (P < 0.05) were also observed. MEFV gene mutations may be associated with particular findings and lesion sites.
Collapse
Affiliation(s)
- Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Nagano, Japan
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yamato Nishiguchi
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Natsuko Kato
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akane Mizutani
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kei Tachibana
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yoshinori Hirata
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hirofumi Matsuyama
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Ai Ogawa-Ito
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| |
Collapse
|
103
|
Mousa AE, Okasha M, Isaacs JD, Price DA, Bhatnagar P, Joshi A, Surash S. Brain pseudotumour secondary to Behçet's disease. Ann R Coll Surg Engl 2019; 101:e164-e168. [PMID: 31537109 PMCID: PMC6818074 DOI: 10.1308/rcsann.2019.0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2018] [Indexed: 11/22/2022] Open
Abstract
Neuro-Behçet's disease (NBD) is a serious manifestation of Behçet's disease (BD) and can affect either the central or peripheral nervous systems, or both. It occurs in 10-50% of patients with BD. We report on a patient with an unusual intraparenchymal lesion, initially thought to be a brain tumour. Histological examination revealed vasculitis consistent with BD. Clinicians should include NBD as a differential diagnosis when considering an isolated inflammatory intracranial lesion.
Collapse
Affiliation(s)
- AE Mousa
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - M Okasha
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - JD Isaacs
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - DA Price
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - P Bhatnagar
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - A Joshi
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - S Surash
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| |
Collapse
|
104
|
The Clinical Features and Risk Factors of Parenchymal Neuro-Behcet's Disease. J Immunol Res 2019; 2019:7371458. [PMID: 31612152 PMCID: PMC6757281 DOI: 10.1155/2019/7371458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 07/03/2019] [Accepted: 07/20/2019] [Indexed: 11/17/2022] Open
Abstract
To investigate the clinical features of parenchymal neuro-Behcet's disease (p-NBD), we retrospectively reviewed the medical records of 1009 BD patients admitted to Peking Union Medical College Hospital from 2000 to 2016. Forty-two patients (25 males and 17 females) with p-NBD and eighty-four age- and sex-matched BD patients without neurological involvement who were served as controls were enrolled. Neurological onset was concomitant with the onset of BD in six cases (14.3%). Pyramidal signs (50.0%) and headache (33.3%) were the most common manifestations. On MRI, the lesions were mainly in the midline structures and hyperintense in the T2-weighted image. The most common lesion was the brainstem (54.8%). Spinal cord involvement was observed in five cases, four of which with cervical cord involvement. Multifocal lesions were observed in 13 patients. Ocular involvement was more prevalent in p-NBD (35.7%) (P = 0.041, OR = 2.36, 95% CI = 1.03-5.44) compared with controls. All patients received corticosteroids and immunosuppressants, mainly cyclophosphamide (39/42). Six patients with severe/refractory condition received biological agents and achieved response measured by decreased Rankin score (P = 0.002). With a median follow-up of 28 months, 22 patients (61.1%) achieved clinical improvements, while 10 (27.8%) relapsed and 4 died (mortality rate 11.1%). p-NBD is a rare yet disabling and life-threatening complication of BD. Ocular involvement is a risk factor for p-NBD. Promptly aggressive treatment is essential for improving prognosis, and biological agents might be a promising approach for severe/refractory p-NBD.
Collapse
|
105
|
Fisher CA, Bernard C. A Systematic Review of Neurocognitive Functioning in Behçet's Disease. Neuropsychol Rev 2019; 29:498-521. [PMID: 31494834 DOI: 10.1007/s11065-019-09416-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/21/2019] [Indexed: 11/25/2022]
Abstract
Behçet's disease (BD) is a vascular, inflammatory multisystem disorder with neuro-Behçet's (NBD) diagnosed in a subset of patients with neurological manifestations. The objective of this review was to determine whether neurocognitive dysfunction is observed in BD, in which neurocognitive domains, and whether there are differences in rates of dysfunction observed between BD and NBD groups. Studies of any methodology were included that reported results from standardized neurocognitive assessment measures in participants with BD or NBD. Twelve group comparison studies met the criteria for inclusion in the review (totalling 284 BD and 157 NBD participants), as well as 17 case study/series papers (11 BD, 35 NBD). Issues with blinding, incomplete data reporting and selective reporting bias were found across the group and case study/series papers, as well as inadequate statistical adjustment for multiple comparisons in the group studies, and the lack of the use of appropriate norms or adjustment for premorbid ability in the case series/studies papers. These quality issues impacted on the conclusions that could be drawn from the current literature. Neurocognitive dysfunction was found in NBD compared to health controls (HC) in a higher proportion of results across studies, than in comparisons between BD and HC groups. The domains in which neurocognitive attenuation was most often reported were visual spatial ability, working memory and acquired knowledge, with more than 25% of these results showing significantly lower functioning in both the BD and NBD groups compared to HC. More than 25% of the processing speed and long-term memory encoding and retrieval results were also lower for the NBD group, compared to HC. Group comparisons between NBD and multiple sclerosis participants indicated few significant differences in neurocognitive test results. The majority of case study/series participants were found to have some degree of attenuated neurocognitive functioning, as defined by case study/series authors.
Collapse
Affiliation(s)
- Caroline A Fisher
- Allied Health - Psychology, Melbourne Health, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, Victoria, 3052, Australia.
- Neuropsychology Service, The Melbourne Clinic, Healthscope, Richmond, Melbourne, Australia.
| | - Coco Bernard
- Allied Health - Psychology, Melbourne Health, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, Victoria, 3052, Australia
- Adult Neuropsychology Service, Rehabilitation and Aged Care Services, Monash Health, Kingston Centre, Cheltenham, Australia
- Adult Neuropsychology Service, Rehabilitation and Aged Care, Monash Health, Caulfield Hospital, Caulfield, Australia
| |
Collapse
|
106
|
Shahram F, Mæhlen MT, Akhlaghi M, Davatchi F, Liao YJ, Weyand CM. Geographical variations in ocular and extra-ocular manifestations in Behçet's disease. Eur J Rheumatol 2019; 6:199-206. [PMID: 31329543 DOI: 10.5152/eurjrheum.2019.18215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/16/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Behçet's disease (BD) is a rare vasculitis that results in multi-organ inflammatory disease. At-risk populations are most prevalent in the Middle East and East Asia. Clinical data on BD in Western countries, especially in the United States, are scarce. We have compared clinical patterning of BD vasculitis in two geographically defined patient cohorts in the Western United States and Iran. METHODS Comparative analysis of a retrospective cohort of 56 patients with BD evaluated at Stanford University Hospital between 2000 and 2016 and a cohort of 163 patients from the BD Registry at Tehran University of Medical Sciences. Clinical, demographic, laboratory, and treatment data were available. Comparisons were performed using descriptive statistics, Student's t-test, and χ2-test. RESULTS The Stanford patients with BD were significantly younger at disease onset, had a higher proportion of females, and had longer disease duration than Iranian patients with BD. Genital ulcers, skin, joint, neurological, vascular, cardiopulmonary manifestations were all significantly more common in the Stanford cohort and 38% of Stanford patients had four or more organ systems involved compared with approximately 10% of Iranian patients. In contrast, Stanford patients had fewer ocular lesions (Stanford 21.4% vs. Iran 53.4% p<0.05), with the biggest difference seen for retinal vasculitis. CONCLUSION Patients with BD from the Western US have a more severe disease course when compared to Iranian patients with BD, as demonstrated by earlier onset and a higher rate of multi-organ involvement. The high risk of Iranian patients with BD developing vasculitis of ocular structures suggests distinct pathomechanisms driving ocular versus extra-ocular BD.
Collapse
Affiliation(s)
- Farhad Shahram
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA.,Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marthe T Mæhlen
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Massoomeh Akhlaghi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereydoun Davatchi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaping Joyce Liao
- Department of Ophthalmology and Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Cornelia M Weyand
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
107
|
Fujimori J, Takahashi T, Matsumoto Y, Fujihara K, Takai Y, Misu T, Nakashima I. Two Japanese cases of anti-MOG antibody-associated encephalitis that mimicked neuro-Behçet's disease. J Neuroimmunol 2019; 334:577002. [PMID: 31279093 DOI: 10.1016/j.jneuroim.2019.577002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/17/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022]
Abstract
Recently, we documented two Japanese cases of myelin-oligodendrocyte glycoprotein (MOG) antibody-associated relapsing encephalitis among patients who had been diagnosed with probable neuro-Behçet's disease (NBD). They presented partial systemic BD symptoms, brainstem lesions, and the human leukocyte antigen (HLA) B51 allele and responded well to steroid therapy. Our cases suggest that we need to differentiate anti-MOG antibody-associated encephalitis from probable NBD because both disorders can present with brainstem or cerebral lesions, CSF pleocytosis, and elevated levels of CSF IL-6 and respond to steroid treatment. Furthermore, oral ulceration, skin lesions, and HLA-B51 might be observed nonspecifically in patients with anti-MOG antibody-associated encephalitis.
Collapse
Affiliation(s)
- Juichi Fujimori
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurology, National Hospital Organization Yonezawa National Hospital, Yonezawa, Japan
| | - Yuki Matsumoto
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, School of Medicine and Multiple Sclerosis, Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuro Misu
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| |
Collapse
|
108
|
Watanabe E, Tanaka A, Sugawara H, Nishina K, Yabe H, Gono T, Terai C. Unclassified Vasculitis with Episcleritis, Thrombophlebitis, Deep Vein Thrombosis, Pulmonary Vasculitis, and Intracranial Vasculitis: An Autopsy Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:886-895. [PMID: 31230060 PMCID: PMC6604764 DOI: 10.12659/ajcr.915527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/18/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Systemic vasculitides constitute heterogenous conditions affecting many organs and systems through blood vessel inflammation. Although there are some classifications for vasculitis, several vasculitides are "unclassified" because they cannot be clearly assigned to one of the known entities. CASE REPORT We report an autopsy case of a 67-year-old Japanese man who presented with fever, ocular pain, erythema, chest pain, and headache. The disease caused episcleritis, thrombophlebitis, extensive deep vein thrombosis, multiple pulmonary nodules and masses, hypertrophic pachymeningitis, and hyper-intensity areas in brain parenchyma on magnetic resonance images. Histopathology of the pulmonary nodule confirmed vasculitis affecting medium-to-small veins and arteries without necrotizing vasculitis or granulomatous inflammation. We diagnosed the patient with unclassified vasculitis based on the clinicopathological characteristics. Steroids in combination with immunosuppressants were used, but the disease was refractory and relapsing. The disease activity was eventually controlled with rituximab, but the patient died of bronchopneumonia. On autopsy, lung and brain findings indicated healed vascular inflammation. CONCLUSIONS This is the first case report of unclassified vasculitis, which is characterized as medium-to-small-sized arteritis and phlebitis, causing episcleritis, thrombophlebitis, deep vein thrombosis, pulmonary vasculitis, and intracranial vasculitis. The clinical conditions share some similarities with granulomatosis with polyangiitis and Behçet's disease; however, they meet no classification criteria of any specific vasculitis. More cases need to be analyzed to confirm our findings.
Collapse
Affiliation(s)
- Eri Watanabe
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
| | - Akira Tanaka
- Department of Pathology, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
| | - Hitoshi Sugawara
- Department of General Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
| | - Kumiko Nishina
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
- Department of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Yabe
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
| | - Takahisa Gono
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
| | - Chihiro Terai
- Department of Rheumatology, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
| |
Collapse
|
109
|
Berlit P, Krämer M. Primary angiitis of the CNS (PACNS) and Behçet disease. Neurol Res Pract 2019; 1:10. [PMID: 33324876 PMCID: PMC7650140 DOI: 10.1186/s42466-019-0014-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/28/2019] [Indexed: 11/15/2022] Open
Abstract
Cerebral vasculitis is a rare disorder but plays a major role in the differential diagnosis of stroke, encephalopathy and headache. This guideline was developed in order to support clinicians in the diagnosis and treatment of primary angiitis of the CNS (PACNS) and Neuro-Behçet. It is based on a medline research and was developed in a modified Delphi process and approved by the involved societies. This article is an abridged and translated version of the guideline published in DGNeurologie: Berlit, P. & Krämer, M. DGNeurologie (2018) 1: 17. 10.1007/s42451-018-0001-y
Collapse
Affiliation(s)
- Peter Berlit
- Deutsche Gesellschaft für Neurologie, Reinhardtstr. 27 C, 10117 Berlin, Germany
| | - Markus Krämer
- Neurologie, Alfried-Krupp-Krankenhaus Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | | |
Collapse
|
110
|
Alis D, Alis C, Tutuncu M, Kocer N, Islak C, Kizilkilic O. Apparent diffusion coefficient characteristics of parenchymal neuro-Behçet's disease. Int J Rheum Dis 2019; 22:1452-1458. [PMID: 30860316 DOI: 10.1111/1756-185x.13542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 01/30/2023]
Abstract
AIM To evaluate apparent diffusion coefficient (ADC) characteristic of parenchymal neuro-Behçet's disease (NBD). METHODS We retrospectively reviewed cranial magnetic resonance imaging (MRI) examinations of NBD patients with acute or chronic parenchymal lesions. ADC measurements of the lesions and contralateral normal brain parenchyma were performed by a consensus of two radiologists. To compare the ADC value of the chronic and acute lesions, relative ADC values (rADC) were calculated. The ratio of the lesions' ADC to contralateral normal brain parenchyma ADC yielded a rADC value of the lesions. Contrast enhancement patterns and the locations of the lesions were also noted. RESULTS A total of 24 NBD patients with 45 parenchymal lesions, 25 acute, and 20 chronic, were enrolled in the study. A significant difference was observed between the mean ADC value of the acute lesions (1074.48 ± 138.31 m/s) and the mean ADC value of the contralateral normal brain parenchyma (841.20 ± 142.96 m/s; P < 0.0001). A significant difference was observed between the mean ADC value of the chronic lesions (1069.95 ± 143.95 m/s) and the mean ADC value of the contralateral normal brain parenchyma (793.90 ± 96.71 m/s; P < 0.0001). No significant difference was observed between the mean rADC (1.35 ± 0.20) and the mean rADC value of the chronic lesions (1.29 ± 0.15; P = 0.22). CONCLUSIONS ADC measurements might provide substantial information about the histopathological aspect of parenchymal NBD lesions.
Collapse
Affiliation(s)
- Deniz Alis
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Halkali/Istanbul, Turkey
| | - Ceren Alis
- Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Melih Tutuncu
- Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Naci Kocer
- Cerrahpasa Faculty of Medicine, Department of Radiology, Istanbul University, Istanbul, Turkey
| | - Civan Islak
- Cerrahpasa Faculty of Medicine, Department of Radiology, Istanbul University, Istanbul, Turkey
| | - Osman Kizilkilic
- Cerrahpasa Faculty of Medicine, Department of Radiology, Istanbul University, Istanbul, Turkey
| |
Collapse
|
111
|
Protean Neurologic Manifestations of Two Rare Dermatologic Disorders: Sweet Disease and Localized Craniofacial Scleroderma. Curr Neurol Neurosci Rep 2019; 19:11. [DOI: 10.1007/s11910-019-0929-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
112
|
Robson JC, Jayne D, Merkel PA, Dawson J. Systemic vasculitis and patient-reported outcomes: how the assessment of patient preferences and perspectives could improve outcomes. Patient Relat Outcome Meas 2019; 10:37-42. [PMID: 30804691 PMCID: PMC6372855 DOI: 10.2147/prom.s163601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The systemic vasculitides are a group of multisystem diseases, which can be life and organ threatening. High-dose immunosuppressants are required to control inflammation in vital organs, such as the kidneys, lungs, skin, joints, and eyes. Patients report a range of impacts on their health-related quality of life due to symptoms, irreversible damage, and the adverse effects of medications. The measurement of patient perspectives within clinical studies in vasculitis is essential to capture outcomes of greatest importance to patients. Validated generic, disease-specific and symptom-specific patient-reported outcomes available for use in patients with systemic vasculitis are reviewed here.
Collapse
Affiliation(s)
- Joanna C Robson
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK,
- Faculty of Health and Applied Sciences, University Hospitals Bristol NHS Trust, Bristol, UK,
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine
- Department of Biostatistics, Epidemiology, and Informatic, University of Pennsylvania, Philadelphia, PA, USA
| | - Jill Dawson
- Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK
| |
Collapse
|
113
|
Kim SW, Kim TG, Oh J, Kim DY, Choi YC, Kim SM, Shin HY, Bang D. Clinical and Radiographic Characteristics of Neuro-Behçet's Disease in South Korea. J Clin Neurol 2019; 15:429-437. [PMID: 31591829 PMCID: PMC6785476 DOI: 10.3988/jcn.2019.15.4.429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose Neurological involvement in Behçet's disease [neuro-Behçet's disease (NBD)] is uncommon, but it is worth investigating since it can cause substantial disability. However, difficulties exist in understanding the clinical features of NBD due to regional variations and the lack of studies utilizing well-established diagnostic criteria. We therefore analyzed the clinical features of patients with NBD based on the recent international consensus recommendation. Methods We retrospectively searched electronic databases for patients with Behçet's disease (BD) between 2000 and 2017, and reviewed their medical records. Based on the recent international consensus recommendation, patients with definite or probable NBD were included. Results Of 9,817 patients with the diagnosis code for BD, 1,682 (17.1%) visited the neurology clinic and 110 (1.1%) were classified as NBD. Ninety-eight patients exhibited parenchymal NBD and 12 exhibited nonparenchymal NBD. Their age at the onset of NBD was 37.6±10.6 years and the male-to-female ratio was 1.24:1. Brainstem syndrome (43.9%) was the most common condition in the 98 patients with parenchymal NBD, followed by multifocal (32.7%) and spinal cord (12.2%) syndromes. 72.4% exhibited acute NBD and 27.6% exhibited a progressive disease course. Frequent manifestations included pyramidal signs (52.0%), headache (45.9%), dysarthria (42.9%), and fever (31.6%). A frequent pattern in brain MRI was an upper brainstem lesion extending to the thalamus and basal ganglia. Conclusions Approximately 1% of the patients with suspected BD exhibited NBD. Neurologists must understand the clinical characteristics of NBD in order to perform the differential diagnosis and management of these patients.
Collapse
Affiliation(s)
- Seung Woo Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Gyun Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jongwook Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Chul Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
| | - Dongsik Bang
- Department of Dermatoloy, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea.
| |
Collapse
|
114
|
Which treatment strategies for polyrefractory Neuro-Behçet disease? Mult Scler Relat Disord 2019; 27:203-205. [DOI: 10.1016/j.msard.2018.10.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022]
|
115
|
|
116
|
Ovcharov PS, Lisitsyna TA, Veltishchev DY, Burenchev DV, Ishchenko DA, Seravina OF, Kovalevskaya OB, Alekberova ZS, Nasonov EL. Cognitive disorders in Behçet's disease. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:11-17. [DOI: 10.17116/jnevro201911902111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
117
|
Manasson J, Howard J, Nowatzky J. Brainstem astrocytoma as a neuro-Behçet's disease mimic. BMJ Case Rep 2018; 11:11/1/e226945. [PMID: 30567204 DOI: 10.1136/bcr-2018-226945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 58-year-old man with a history of recurrent aphthous ulcers since childhood was admitted to the hospital with acute neurological decline characterised by loss of motor dexterity, dysarthria, dysphagia and unsteady gait. MRI brain was significant for symmetrical hyperintense T2 fluid attenuated inversion recovery (FLAIR) in the corticospinal tracts, including parts of the pons and the mesodiencephalic junction. Though initial concern was for neuro-Behçet's disease, brain biopsy ultimately revealed a diagnosis of astrocytoma. This report demonstrates a mimic of neuro-Behçet's disease and the importance of confirming the correct diagnosis prior to initiating therapy.
Collapse
Affiliation(s)
- Julia Manasson
- Internal Medicine, Division of Rheumatology, New York University, New York City, New York, USA
| | - Jonathan Howard
- Neurology and Psychiatry, New York University, New York City, New York, USA
| | - Johannes Nowatzky
- Internal Medicine, Division of Rheumatology, New York University, New York City, New York, USA
| |
Collapse
|
118
|
Zarei S, Eggert J, Franqui-Dominguez L, Carl Y, Boria F, Stukova M, Avila A, Rubi C, Chinea A. Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico. Surg Neurol Int 2018; 9:242. [PMID: 30603227 PMCID: PMC6293609 DOI: 10.4103/sni.sni_224_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
Neuromyelitis optica (NMO) is an immune-mediated inflammatory disorder of the central nervous system. It is characterized by concurrent inflammation and demyelination of the optic nerve (optic neuritis [ON]) and the spinal cord (myelitis). Multiple studies show variations in prevalence, clinical, and demographic features of NMO among different populations. In addition, ethnicity and race are known as important factors on disease phenotype and clinical outcomes. There are little data on information about NMO patients in underserved groups, including Puerto Rico (PR). In this research, we will provide a comprehensive overview of all aspects of NMO, including epidemiology, environmental risk factors, genetic factors, molecular mechanism, symptoms, comorbidities and clinical differentiation, diagnosis, treatment, its management, and prognosis. We will also evaluate the demographic features and clinical phenotype of NMO patients in PR. This will provide a better understanding of NMO and establish a basis of knowledge that can be used to improve care. Furthermore, this type of population-based study can distinguish the clinical features variation among NMO patients and will provide insight into the potential mechanisms that cause these variations.
Collapse
Affiliation(s)
- Sara Zarei
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - James Eggert
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Yonatan Carl
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Fernando Boria
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Marina Stukova
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Cristina Rubi
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
| | - Angel Chinea
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
| |
Collapse
|
119
|
Hibberd O, Bhomra P, Ahmad A. Radiological Neuro-BehçEt'S Associated with Bipolar Disorder: First Presentation of a Multisystem Disease. J R Coll Physicians Edinb 2018; 48:323-327. [DOI: 10.4997/jrcpe.2018.408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Behçet's disease is a chronic, relapsing, systemic inflammatory disease affecting the orogenital mucosa, eyes, joints, blood vessels, nervous system and intestines. The prevalence of neurological involvement varies geographically and can include psychiatric manifestations. Current evidence for a causal association between Behçet's disease and bipolar disorder is limited to a small number of case reports. We report a case of a patient with a recent diagnosis of bipolar disorder who was subsequently diagnosed with Behçet's disease. The 38-year-old male presented with a 6-month history of right eye visual blurring, 5-month history of mouth ulcers and 3 months of genital ulceration. His inflammatory markers were raised. An MRI of the brain was conducted in the absence of any focal neurological signs or symptoms owing to his past psychiatric history. The MRI showed changes in the medial aspect of the right temporal lobe highly suspicious of neuro-Behçet's disease. His inpatient care was coordinated with neurology, rheumatology, ophthalmology and psychiatry teams, and he was later discharged with outpatient follow up owing to a clinical improvement on high-dose steroids. This case shows that, although widely unrecognised, neuro-Behçet's can occur in the absence of focal neurology. Additionally, neuro-Behçet's should be considered in patients with bipolar disorder presenting with symptoms suggestive of Behçet's disease. The case emphasises how patients presenting with ulceration, mood disorder and visual changes should not have these symptoms considered in isolation and multisystem disease should be considered. Furthermore, the coordinated multidisciplinary approach required for the care of patients with Behçet's disease is demonstrated.
Collapse
Affiliation(s)
- O Hibberd
- Senior House Officer Emergency Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Bhomra
- Speciality Registrar Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Ahmad
- Consultant Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
120
|
Sorgun MH, Kural MA, Yücesan C. Clinical characteristics and prognosis of Neuro-Behçet's disease. Eur J Rheumatol 2018; 5:235-239. [PMID: 30308139 PMCID: PMC6267754 DOI: 10.5152/eurjrheum.2018.18033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/15/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Neuro-Behçet's disease (NBD) is a rare manifestation of Behçet's disease (BD) and may cause severe disability. The aim of this study was to evaluate the treatment response in patients with NBD and to investigate the parameters that may influence the prognosis of the disease in patients with severe to mild-moderate disability. METHODS The files of 60 patients admitted to our outpatient clinic for NBD between January 2007 and June 2014 were retrospectively reviewed. We compared the BD duration, time to NBD, NBD type and course, clinical findings of BD, functional neurological system involvement, localization of lesions on brain MRI, and all the medications between the severe and mild-moderate disability groups. RESULTS The mean time to the onset of NBD was significantly longer (17.8±4.6 years) and the mean age was significantly higher (50.25±9.1 years) in patients with severe disability than in those with mild-moderate disability (7.5±8.0 years and 37.5±10.9 years; p=0.01 and p=0.03, respectively). Moreover, hemispheric involvement was significantly associated with severe disability (p=0.006). No difference was found with regard toother investigated parameters between the groups. CONCLUSION We believe that severe neurological disability may be associated with older age at the onset of NBD or longer time to NBD and hemispheric lesions on brain MRI. However, our results should be cautiously evaluated with further research.
Collapse
Affiliation(s)
- Mine Hayriye Sorgun
- Department of Neurology, Ankara University School of Medicine, İbni Sina Hospital, Ankara, Turkey
| | - Mustafa Aykut Kural
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Canan Yücesan
- Department of Neurology, Ankara University School of Medicine, İbni Sina Hospital, Ankara, Turkey
| |
Collapse
|
121
|
Shimizu F, Nishihara H, Kanda T. Blood-brain barrier dysfunction in immuno-mediated neurological diseases. Immunol Med 2018; 41:120-128. [PMID: 30938273 DOI: 10.1080/25785826.2018.1531190] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The blood-brain barrier (BBB) is the brain-specific endothelial cell barrier that is important for maintaining brain homeostasis and preventing the entry of toxic substances. Pathological BBB dysfunction is a critical step of the disease process in several immuno-mediated neurological diseases, including multiple sclerosis (MS), neuromyelitis optica (NMO), neuropsychiatric systemic lupus erythematosus (NPSLE) and neuro-Behçet diseases. The pathological findings from patients with secondary progressive (SP) MS, NMO and NPSLE showed leaky BBB in the active lesions. NMO is a disease with strong evidence of disease-specific and pathogenic autoantibodies (aquaporin 4 [AQP4] autoantibodies). In the development of NMO, circulating AQP4 autoantibodies need to pass through the BBB in order to reach AQP4 on the astrocyte endfeet. Strong evidence suggests that NPSLE is associated with the disruption of the BBB and NPSLE patients frequently have antibodies bound to endothelial cells in their sera. We recently identified two BBB-reactive autoantibodies in immuno-mediated neurological diseases: galectin-3 autoantibodies in SPMS and GRP78 autoantibodies in NMO. In the present review article, we describe the basic structure and cellular biology of the BBB, discuss recent insights regarding the pathophysiology of the BBB breakdown in the setting of immuno-mediated neurological diseases, and describe our recent findings of autoantibody-mediated BBB breakdown.
Collapse
Affiliation(s)
- Fumitaka Shimizu
- a Department of Neurology and Clinical Neuroscience , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Hideaki Nishihara
- a Department of Neurology and Clinical Neuroscience , Yamaguchi University Graduate School of Medicine , Ube , Japan
| | - Takashi Kanda
- a Department of Neurology and Clinical Neuroscience , Yamaguchi University Graduate School of Medicine , Ube , Japan
| |
Collapse
|
122
|
Neuro-Behcet's disease in a case with papilledema and intracranial hypertension as the initial presentation. North Clin Istanb 2018; 5:153-156. [PMID: 30374484 PMCID: PMC6191548 DOI: 10.14744/nci.2017.49344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 09/30/2017] [Indexed: 11/26/2022] Open
Abstract
A 27-year-old female presented to the Clinic of Ophthalmology with the complaints of photophobia, headache, and diplopia. An ophthalmological examination indicated that her best-corrected visual acuity was 20/20 in both eyes with decreased contrast sensitivity. Fundoscopic examination revealed bilateral papilledema. The cerebrospinal fluid opening pressure was above normal at 38.5 cm H2O. Cranial magnetic resonance imagining venography revealed left lateral sinus thrombosis and right lateral sinus retardation of filling. Based on her history, laboratory tests, and neuro-imaging findings, she was diagnosed with vascular neuro-Behcet’s disease (NBD). It is important to consider NBD in the differential diagnosis of patients with bilateral papilledema and intracranial hypertension.
Collapse
|
123
|
Dormegny L, Chibbaro S, Ganau M, Santin M, Kremer L, Proust F. Biopsying a spinal cord lesion: A diagnostic dilemma. Case report and review of literature. Neurochirurgie 2018; 64:425-430. [PMID: 30243464 DOI: 10.1016/j.neuchi.2018.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/24/2018] [Accepted: 07/23/2018] [Indexed: 12/29/2022]
Abstract
Spinal cord biopsy is a difficult procedure fraught with the risk of false-negative results or even misdiagnosis in up to 30% of cases. Differential diagnoses of spinal cord lesions include a wide range of inflammatory, infectious and neoplastic diseases. Given the importance of correctly managing these pathologies, it is crucial to avoid delays in making the correct diagnosis in order to improve the patient's outcome. We present here the case of a 21-year-old male with rapidly progressing sphincter and lower limb motor dysfunctions up to complete paraplegia with evidence of thoracic spinal cord lesion on magnetic resonance imaging. None of the blood and cerebrospinal fluid tests pointed to a diagnosis, while a first spinal cord biopsy revealed an inflammatory necrotic process. After several weeks of empirical treatments and clinical stability, the patient started having focal structural seizures that became generalized with local progression of the lesion and diffuse leptomeningeal spread on magnetic resonance imaging. A second spinal cord biopsy found a grade IV glioblastoma with H3 K27M histone mutation. Unfortunately the patient passed away before any treatment could be initiated. In this report, the authors analyze the difficulty of making the rapid, correct diagnosis of a highly malignant intrinsic spinal cord lesion, discussing also possible strategies to avoid diagnostic delays and to improve the outcome of these difficult patients.
Collapse
Affiliation(s)
- L Dormegny
- Service de neurochirurgie, CHU de Strasbourg, hôpital de Hautepierre, 67000 Strasbourg, France.
| | - S Chibbaro
- Service de neurochirurgie, CHU de Strasbourg, hôpital de Hautepierre, 67000 Strasbourg, France
| | - M Ganau
- Service de neurochirurgie, CHU de Strasbourg, hôpital de Hautepierre, 67000 Strasbourg, France
| | - Mdn Santin
- Service de neurochirurgie, CHU de Strasbourg, hôpital de Hautepierre, 67000 Strasbourg, France
| | - L Kremer
- Service de neurologie, CHU de Strasbourg, hôpital de Hautepierre, 67000 Strasbourg, France
| | - F Proust
- Service de neurochirurgie, CHU de Strasbourg, hôpital de Hautepierre, 67000 Strasbourg, France
| |
Collapse
|
124
|
Ptosis and Mass Like Lesions in Behçet's Disease: A Rare Presentation. Arch Rheumatol 2018; 33:221-224. [PMID: 30207574 DOI: 10.5606/archrheumatol.2018.6515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/31/2017] [Indexed: 11/21/2022] Open
Abstract
In this article, we describe a case of neuro-Behçet's disease presenting with unilateral ptosis and facial paresis due to an intracranial mass lesion. A 25-year-old male patient with a history of Behçet's disease presented with headache, vertigo, double vision, ptosis in his right eyelid and slurred speech. Cranial magnetic resonance imaging scan revealed a right-sided capsulothalamic lesion, which was extending to the right cerebral pedicle, pons and superior cerebellar pedicle. This lesion was interpreted as neuro-Behçet's disease involvement of central nervous system. Cerebral mass- like lesion is a rare form of neuro-Behçet's disease. Review of the literature revealed a limited number of cases. Ptosis related with Behçet's disease is also a very rare presentation. This case shows that this symptom might be a part of the clinical presentation of neuro-Behçet's disease.
Collapse
|
125
|
Ryu HJ, Seo MR, Choi HJ, Baek HJ. Clinical phenotypes of Korean patients with Behcet disease according to gender, age at onset, and HLA-B51. Korean J Intern Med 2018; 33:1025-1031. [PMID: 28073242 PMCID: PMC6129630 DOI: 10.3904/kjim.2016.202] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/23/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND/AIMS The clinical manifestations of Behcet disease (BD) have been reported to differ according to country, region, and race. Gender, onset age, and human leukocyte antigen (HLA)-B51 have also been known as the factors that influence the clinical features of BD. The aim of this study is to investigate the clinical phenotypes of Korean patients who visited the rheumatology clinic with BD with respect to gender, onset age, and HLA-B51. METHODS Total 193 Korean patients (129 females and 64 males) fulfilling the international criteria for BD were retrospectively assessed. RESULTS The mean age at disease onset and disease duration of the BD patients were 32.2 ± 11.1 and 14.2 ± 9.3 years, retrospectively. Females suffered more frequently from genital ulcers (90.7% vs. 75.0%, p < 0.01), peripheral arthritis (67.4% vs. 43.8%, p < 0.01), and inf lammatory low back pain (38.8% vs. 23.4%, p = 0.03) than males, while skin involvement was more frequent in males than in females (90.6% vs. 75.2%, p = 0.01). The patients with late onset of BD (> 40 years) suffered from neurologic involvement (15.9% vs. 4.2%, p = 0.007) more frequently than those with early onset of BD. The patients with HLA-B51 showed earlier onset of disease than without HLA-B51 (28.3 ± 11.4 years vs. 33.8±11.6 years, p = 0.02) and the neurologic and gastrointestinal involvements were more frequent in the patients without HLA-B51 than with HLA-B51 (17.2% vs. 2.5%, p = 0.02 and 20.7% vs. 2.5%, p = 0.01, respectively). CONCLUSION The clinical phenotypes in Korean patients with BD may be influenced by gender, onset age and HLA-B51.
Collapse
Affiliation(s)
- Hee Jung Ryu
- Department of Rheumatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Mi Ryoung Seo
- Department of Rheumatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyo Jin Choi
- Department of Rheumatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Han Joo Baek
- Department of Rheumatology, Gachon University Gil Medical Center, Incheon, Korea
- Correspondence to Han Joo Baek, M.D. Department of Rheumatology, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel: +82-32-460-8426 Fax: +82-32-460-8410 E-mail:
| |
Collapse
|
126
|
Uluduz D, Midi I, Duman T, Colakoglu S, Tüfekci A, Bakar M, Nazliel B, Tascilar N, Goksan B, Sungur MA, Kozak HH, Demir S, Misirli CH, Kucukoglu H, Cinar N, Domac FM, Ozturk S, Yayla V, Karahan AY, Afsar N, Goksu EO, Mengulluoglu N, Aytac E, Yesilot N, Ince B, Yalin OO, Oruc S, Demirci S, Senol MG, Yilmaz A, Gokce M, Yilmaz Kusbeci Ö, Uzuner G, Batur Caglayan HZ, Acikgoz M, Zeydan B, Ozdag F, Baybas S, Ekmekci H, Cabalar M, Yaman M, Yurekli VA, Tekeli H, Genc H, Utku U, Ucan Tokuc FE, Uzuner N, Bektas H, Kablan Y, Goksel BK, Milanlioglu A, Necioglu Orken D, Aluclu U. Behçet’s disease as a causative factor of cerebral venous sinus thrombosis: subgroup analysis of data from the VENOST study. Rheumatology (Oxford) 2018; 58:600-608. [DOI: 10.1093/rheumatology/key153] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 04/26/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
This study was performed to determine the rate of cerebral venous sinus thrombosis (CVST) among cases of Behçet’s disease (BD) included in a multicentre study of cerebral venous sinus thrombosis (VENOST).
Methods
VENOST was a retrospective and prospective national multicentre observational study that included 1144 patients with CVST. The patients were classified according to aetiologic factors, time of CVST symptom onset, sinus involvement, treatment approach and prognosis.
Results
BD was shown to be a causative factor of CVST in 108 (9.4%) of 1144 patients. The mean age of patients in the BD group was 35.27 years and 68.5% were men, whereas in the non-BD CVST group, the mean age was 40.57 years and 28.3% were men (P < 0.001). Among the aetiologic factors for patients aged 18–36 years, BD was predominant for men, and puerperium was predominant for women. The onset of symptoms in the BD group was consistent with the subacute form. The transverse sinuses were the most common sites of thrombosis, followed by the superior sagittal sinuses. The most common symptom was headache (96.2%), followed by visual field defects (38%).
Conclusions
BD was found in 9.4% of patients in our VENOST series. Patients with BD were younger and showed a male predominance. The functional outcome of CVST in patients with BD was good; only 12% of patients presenting with cranial nerve involvement and altered consciousness at the beginning had a poor outcome (modified Rankin Score ⩾2).
Collapse
Affiliation(s)
- Derya Uluduz
- School of Medicine, Department of Neurology, Istanbul Cerrahpasa University, Istanbul
| | - Ipek Midi
- School of Medicine, Department of Neurology, Marmara University, Istanbul
| | - Taskin Duman
- School of Medicine, Department of Neurology, Mustafa Kemal University, Hatay
| | - Sena Colakoglu
- School of Medicine, Department of Neurology, Mustafa Kemal University, Hatay
| | - Ahmet Tüfekci
- School of Medicine, Department of Neurology, Recep Tayyip Erdoğan University, Rize
| | - Mustafa Bakar
- School of Medicine, Department of Neurology, Uludağ University, Bursa
| | - Bijen Nazliel
- School of Medicine, Department of Neurology, Gazi University, Ankara
| | - Nida Tascilar
- School of Medicine, Department of Neurology, Bülent Ecevit University, Zonguldak
| | - Baki Goksan
- School of Medicine, Department of Neurology, Istanbul Cerrahpasa University, Istanbul
| | - Mehmet Ali Sungur
- School of Medicine, Department of Biostatistics, Düzce University, Düzce
| | - Hasan Huseyin Kozak
- School of Medicine, Department of Neurology, Necmettin Erbakan University, Konya
| | - Serkan Demir
- Clinic of Neurology, Sultan Abdulhamid Han Research and Training Hospital, Istanbul
| | - Cemile Handan Misirli
- Clinic of Neurology, Haydarpasa Training and Research Hospital, Health Sciences University, Istanbul
| | - Hayriye Kucukoglu
- Clinic of Neurology, Bakirkoy Research and Training Hospital for Neurologic and Psychiatric Diseases, Istanbul
| | - Nilgun Cinar
- School of Medicine, Department of Neurology, Maltepe University, Istanbul
| | - Fusun Mayda Domac
- Clinic of Neurology, Erenkoy Research and Training Hospital for Neurologic and Psychiatric Diseases, Istanbul
| | - Serefnur Ozturk
- School of Medicine, Department of Neurology, Selçuk University, Konya
| | - Vildan Yayla
- Clinic of Neurology, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul
| | - Ali Yavuz Karahan
- School of Medicine, Department of Physical Medicine and Rehabilitation, Usak University, Usak
| | - Nazire Afsar
- School of Medicine, Department of Neurology, Acibadem Mehmet Ali Aydinlar University, Istanbul
| | | | | | - Emrah Aytac
- Clinic of Neurology, Ankara Research and Training Hospital, Ankara
| | - Nilufer Yesilot
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine Istanbul
| | - Birsen Ince
- School of Medicine, Department of Neurology, Istanbul Cerrahpasa University, Istanbul
| | - Ozgur Osman Yalin
- Clinic of Neurology, Istanbul Training and Research Hospital, Health Sciences University, Istanbul
| | - Serdar Oruc
- School of Medicine, Department of Neurology, Kocatepe University, Afyon
| | - Seden Demirci
- School of Medicine, Department of Neurology, Süleyman Demirel University, Isparta
| | - Mehmet Guney Senol
- School of Medicine, Department of Neurology, Istanbul Cerrahpasa University, Istanbul
| | - Arda Yilmaz
- School of Medicine, Department of Neurology, Mersin University, Mersin
| | - Mustafa Gokce
- School of Medicine, Department of Neurology, Kahramanmaras Sutcu Imam University, Kahramanmaras
| | - Özge Yilmaz Kusbeci
- Clinic of Neurology, Bozyaka Education, Research and Training Hospital, İzmir
| | - Gulnur Uzuner
- School of Medicine, Department of Neurology, Osmangazi University, Eskisehir
| | | | - Mustafa Acikgoz
- School of Medicine, Department of Neurology, Bülent Ecevit University, Zonguldak
| | - Burcu Zeydan
- School of Medicine, Department of Neurology, Istanbul Cerrahpasa University, Istanbul
| | - Fatih Ozdag
- Clinic of Neurology, Sultan Abdulhamid Han Research and Training Hospital, Istanbul
| | - Sevim Baybas
- Clinic of Neurology, Bakirkoy Research and Training Hospital for Neurologic and Psychiatric Diseases, Istanbul
| | - Hakan Ekmekci
- School of Medicine, Department of Neurology, Selçuk University, Konya
| | - Murat Cabalar
- Clinic of Neurology, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul
| | - Mehmet Yaman
- School of Medicine, Department of Neurology, Kocatepe University, Afyon
| | - Vedat Ali Yurekli
- School of Medicine, Department of Neurology, Süleyman Demirel University, Isparta
| | - Hakan Tekeli
- Clinic of Neurology, Sultan Abdulhamid Han Research and Training Hospital, Istanbul
| | - Hamit Genc
- School of Medicine, Department of Neurology, Mersin University, Mersin
| | - Uygar Utku
- School of Medicine, Department of Neurology, Kahramanmaras Sutcu Imam University, Kahramanmaras
| | | | - Nevzat Uzuner
- School of Medicine, Department of Neurology, Osmangazi University, Eskisehir
| | - Hesna Bektas
- Clinic of Neurology, Ataturk Research and Training Hospital, Ankara
| | - Yuksel Kablan
- School of Medicine, Department of Neurology, Inonu University, Malatya
| | - Basak K Goksel
- School of Medicine, Department of Neurology, Baskent University, Adana
| | - Aysel Milanlioglu
- School of Medicine, Department of Neurology, Yüzüncü Yıl University, Van, Turkey
| | | | - Ufuk Aluclu
- School of Medicine, Department of Neurology, Dicle University, Diyarbakir, Turkey
| |
Collapse
|
127
|
Altunkaynak Y, Usta Ş, Ertem DH, Köksal A, Dırıcan AC, Baybaş S. Cognitive Functioning and Silent Neurological Manifestations in Behçet's Disease with Ocular Involvement. ACTA ACUST UNITED AC 2018; 56:173-177. [PMID: 31523141 DOI: 10.5152/npa.2017.19406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/18/2017] [Indexed: 11/22/2022]
Abstract
Introduction Various reports have revealed a cognitive dysfunction in Behçet's disease (BD). In this study, we aimed to assess the silent neurological manifestations, behavioral and neuropsychiological impairments of Behçet's disease patients with ocular involvement. Methods Thirty BD patients with ocular involvement in the nonactive phase of their illness were applied detailed neurological examination and magnetic resonance imagining (MRI). Neuropsychological tests were performed. Patients' neuropsychological performances were compared to those of healthy, demographically matched twenty subjects. Results Neurological manifestations of patients were headache (56.6%), pyramidal signs (13.3%), behavioral changes (3.3%) and sensory symptoms (3.3%). Four patients (13.3%) had white matter hyperintensities lesions on T2/FLAIR brain MRI. Fourteen patients (46%) had impaired cognitive performances on the following tasks: verbal memory (immediate memory p=0.000, maximal learning capacity p=0.009, number of repetitions p=0.000, total learning capacity p=0.001, recall p=0.033), nonverbal memory (immediate memory p=0.029, recall p=0.001), logical memory (immediate memory p=0.001, recall p=0.001), executive (frontal) functions (clock-drawing test p=0.000, Stroop test p=0.001, verbal fluency tests p=0.000). Patients' MMSE and clock drawing test scores were significantly lower than controls (p=0.03). Attention deficit was not detected. Behçet's disease patients showed higher scores on depression scales than healthy subjects but there was no statistically significant difference between anxiety scores. Conclusion Neuropsychological deficits, involving mainly memory and executive functioning, subcortical MRI lesions, and non-structural headache may be present in Behçet's disease patients with ocular involvement without overt neurological manifestations.
Collapse
Affiliation(s)
- Yavuz Altunkaynak
- Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, Neurology Clinic, İstanbul, Turkey
| | - Şebnem Usta
- Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, Neurology Clinic, İstanbul, Turkey
| | - Devrimsel Harika Ertem
- Neurology Department, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Ayhan Köksal
- Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, Neurology Clinic, İstanbul, Turkey
| | - Ayten Ceyhan Dırıcan
- Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, Neurology Clinic, İstanbul, Turkey
| | - Sevim Baybaş
- Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, Neurology Clinic, İstanbul, Turkey
| |
Collapse
|
128
|
Watkins S, Gaffo AL, Clark AV, Steinhilber S. An Exercise in Clinical Reasoning: Do You Unpack? J Gen Intern Med 2018; 33:1196-1200. [PMID: 29744719 PMCID: PMC6025687 DOI: 10.1007/s11606-018-4466-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 11/17/2017] [Accepted: 04/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Stacey Watkins
- Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Angelo L Gaffo
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amanda V Clark
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Starr Steinhilber
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
129
|
|
130
|
Rana A, Musto AE. The role of inflammation in the development of epilepsy. J Neuroinflammation 2018; 15:144. [PMID: 29764485 PMCID: PMC5952578 DOI: 10.1186/s12974-018-1192-7] [Citation(s) in RCA: 376] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/06/2018] [Indexed: 12/18/2022] Open
Abstract
Epilepsy, a neurological disease characterized by recurrent seizures, is often associated with a history of previous lesions in the nervous system. Impaired regulation of the activation and resolution of inflammatory cells and molecules in the injured neuronal tissue is a critical factor to the development of epilepsy. However, it is still unclear as to how that unbalanced regulation of inflammation contributes to epilepsy. Therefore, one of the goals in epilepsy research is to identify and elucidate the interconnected inflammatory pathways in systemic and neurological disorders that may further develop epilepsy progression. In this paper, inflammatory molecules, in neurological and systemic disorders (rheumatoid arthritis, Crohn’s, Type I Diabetes, etc.) that could contribute to epilepsy development, are reviewed. Understanding the neurobiology of inflammation in epileptogenesis will contribute to the development of new biomarkers for better screening of patients at risk for epilepsy and new therapeutic targets for both prophylaxis and treatment of epilepsy.
Collapse
Affiliation(s)
- Amna Rana
- Department of Pathology and Anatomy, Department of Neurology, Eastern Virginia Medical School, 700 W. Olney Road, Lewis Hall, Office 2174, Norfolk, VA, 23507, USA
| | - Alberto E Musto
- Department of Pathology and Anatomy, Department of Neurology, Eastern Virginia Medical School, 700 W. Olney Road, Lewis Hall, Office 2174, Norfolk, VA, 23507, USA.
| |
Collapse
|
131
|
|
132
|
Cerebrospinal fluid IL-10 as an early stage discriminative marker between multiple sclerosis and neuro-Behçet disease. Cytokine 2018; 108:160-167. [PMID: 29625335 DOI: 10.1016/j.cyto.2018.03.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/17/2022]
Abstract
Multiple Sclerosis (MS) and Neuro-Behçet's Disease (NBD) are two recurrent disorders affecting the central nervous system (CNS) by causing inflammation and irreversible damage. Inaugural clinical symptoms for both diseases might be very similar and definitive diagnosis could be delayed. The present study aimed to find out possible differences at early stages in the transcription factors/cytokines expression profiles in blood and cerebrospinal fluid (CSF) of MS and NBD patients which could be useful discriminative markers. Cytokines and transcription factors related to Th1, Th2, Th17 and T regulatory populations were studied by quantitative RT-PCR simultaneously in PBMCs and CSF, from 40 patients presenting a first episode of clinical features related to CNS inflammation and 22 controls with non inflammatory neurological diseases enrolled mainly for severe headache. The follow up of 12 months did allow a definitive diagnosis of remitting relapsing MS (RRMS) in 21 patients and of NBD in the other 19 among those with CNS inflammation compared to controls. In initial blood samples, T-bet was significantly increased in NBD patients only while IFN-γ was elevated in patients who evolved into RRMS or NBD. IL-17a, GATA-3 and IL-4 were significantly lower in RRMS patients than in the NBD group. In initial CSF samples, ROR-γt, IL-17a and IFN-γ were significantly elevated in patients compared to controls. The most striking finding was the significant increase of CSF IL-10 that we did observe in NBD patients only. Thus, we propose CSF IL-10 as a predictive marker to help clinicians discriminating between these two neurological disorders.
Collapse
|
133
|
Krumb E, Lefebvre C, Peeters A, Hermans C. Cerebral venous thrombosis revealing Behçet's disease in a Moroccan patient: A case report and literature review. SAGE Open Med Case Rep 2018; 6:2050313X18767053. [PMID: 29623204 PMCID: PMC5881965 DOI: 10.1177/2050313x18767053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/05/2018] [Indexed: 12/22/2022] Open
Abstract
Behçet’s disease is an inflammatory disease, the origin of which still remains unclear, and it has multiple manifestations, one of them being thrombosis. In this report, we describe the case of a 24-year-old Moroccan patient who presented with headache persisting for more than 2 weeks, which was found to be caused by cerebral venous sinus thrombosis. His medical history of recurrent oral and genital ulcerations, epididymitis and one episode of pericarditis led to the diagnosis of Behçet’s disease. We could observe an almost complete relief of symptoms with colchicine therapy, and anticoagulation with warfarin was started for secondary prevention of thrombosis.
Collapse
Affiliation(s)
- Evelien Krumb
- Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Chantal Lefebvre
- Division of General Internal Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - André Peeters
- Division of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Cédric Hermans
- Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
134
|
Roriz M, Crassard I, Lechtman S, Saadoun D, Champion K, Wechsler B, Chabriat H, Sène D. Can anticoagulation therapy in cerebral venous thrombosis associated with Behçet's disease be stopped without relapse? Rev Neurol (Paris) 2018. [PMID: 29523353 DOI: 10.1016/j.neurol.2017.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is as yet no consensus on the treatment of cerebral venous thrombosis (CVT) in Behçet's disease, and the place of anticoagulation is also still being debated. This report is of a series of seven patients with Behçet's disease (BD)-associated CVT, for which anticoagulation was stopped, and discusses the possibility of stopping anticoagulation during follow-up while receiving optimal treatment for BD. The diagnosis of BD was established during follow-up, which lasted a median of 120 [range: 60-1490] days after CVT diagnosis. The median duration of anticoagulation therapy was 29.5 months. On stopping anticoagulation, concomitant treatment then included colchicine, steroids and azathioprine, all introduced after BD was diagnosed. With a median follow-up of 25 months after anticoagulation interruption, only one relapse of CVT was observed. No relapse of CVT or other venous thrombosis was observed in the six patients treated by steroids associated with an immunosuppressant or colchicine. Our results emphasize that corticosteroids are essential for the treatment of BD-associated CVT, and that anticoagulant therapy may be safely stopped during follow-up in the presence of optimal BD treatment (steroids alone or with immunosuppressive drugs).
Collapse
Affiliation(s)
- M Roriz
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France.
| | - I Crassard
- Neurology Department, Lariboisière Hospital, Paris VII University, DHU NeuroVasc, 2 rue Ambroise Paré, 75475 Paris, France
| | - S Lechtman
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France
| | - D Saadoun
- Internal Medicine Department, La Pitié-Salpétrière Hospital, Paris VI University, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - K Champion
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France
| | - B Wechsler
- Internal Medicine Department, La Pitié-Salpétrière Hospital, Paris VI University, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - H Chabriat
- Neurology Department, Lariboisière Hospital, Paris VII University, DHU NeuroVasc, 2 rue Ambroise Paré, 75475 Paris, France
| | - D Sène
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France
| |
Collapse
|
135
|
de la Motte MB, Abbas R, Jouan F, van Gysel D, Chauveheid MP, Papo T, Sacre K. Systemic inflammatory disorders in patients admitted for aseptic meningitis. Clin Med (Lond) 2018; 18:132-137. [PMID: 29626017 PMCID: PMC6303440 DOI: 10.7861/clinmedicine.18-2-132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acute meningitis can be the first manifestation of an underlying systemic inflammatory disorder (SID). In the current study, we aimed to identify clinical indicators for SIDs in patients admitted for acute aseptic meningitis. All patients hospitalised for acute aseptic meningitis over a 4-year period in a department of internal medicine were included retrospectively. Patients with neoplastic meningitis were excluded. Extraneurological signs were recorded using a systematic panel. Systemic inflammatory disorder diagnosis was made according to current international criteria. Forty-three (average age 46 years [range 19-82 years], 60% females) consecutive patients were analysed retrospectively. Of these, 23 patients had an SID (mostly sarcoidosis and Behçet's disease). -Multiple logistic regression analysis showed that the probability of an SID was 93.7% in patients with both neurological and extraneurological signs, but 14.9% in patients with neither neurological nor extraneurological signs. In conclusion, clinical sorting according to both neurological and extraneurological signs could help to identify patients with acute aseptic meningitis caused by an SID.
Collapse
|
136
|
Anaesthetic considerations in a parturient with Behcet’s disease. Int J Obstet Anesth 2018; 33:93-94. [DOI: 10.1016/j.ijoa.2017.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/11/2017] [Accepted: 06/20/2017] [Indexed: 11/18/2022]
|
137
|
Park JW, Joo MC, Lee KM, Kim MS. Effect of Long-term Comprehensive Rehabilitation on Functional Recovery in Recurrent and Refractory Neuro-Behcet's Disease: a Case Report with 4-year Follow-up. BRAIN & NEUROREHABILITATION 2018. [DOI: 10.12786/bn.2018.11.e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ji Woo Park
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Kwang Min Lee
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Min-Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| |
Collapse
|
138
|
Kotan D, Alemdar M, Köksal SA. A Patient with Neuro-Behçet's Syndrome Presenting with Peripheral Nerve Involvement. ACTA ACUST UNITED AC 2017; 54:376-378. [PMID: 29321715 DOI: 10.5152/npa.2017.18121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Dilcan Kotan
- Department of Neurology, Sakarya University School of Medicine Sakarya, Turkey
| | - Murat Alemdar
- Department of Neurology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Semra Alaçam Köksal
- Department of Neurology, Sakarya University School of Medicine Sakarya, Turkey
| |
Collapse
|
139
|
Acute/subacute Neuro-Behcet's disease. Acta Neurol Belg 2017; 117:925-926. [PMID: 28429255 DOI: 10.1007/s13760-017-0780-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
|
140
|
Ko LN, Alloo A, Lin WM, Hoang MP, Kroshinsky D. A 25-Year-Old Male with Orogenital Ulcers, Rash, and Difficulty Swallowing. Dermatopathology (Basel) 2017; 4:7-12. [PMID: 29456995 PMCID: PMC5803722 DOI: 10.1159/000481528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 25-year-old otherwise healthy male presented with new-onset odynophagia, rash, and orogenital ulcers. Despite treatment with antibiotics for presumed bacterial pharyngitis, the patient remained symptomatic, with abnormal vital signs and laboratory values. Upon dermatology consultation and histopathologic correlation, he was diagnosed with Behçet disease. Behçet disease is a rare rheumatologic condition that presents with recurrent oral ulcers and varying degrees of ophthalmic, neurologic, cardiac, and vascular disease. Given its protean nature, the treatment of Behçet disease is tailored to the patient's presentation and severity of organ involvement. Following treatment with colchicine and prednisone, the patient's symptoms improved rapidly.
Collapse
Affiliation(s)
- Lauren N Ko
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Allireza Alloo
- Department of Dermatology, Northwell Health, Lake Success, New York, USA
| | - William M Lin
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Mai P Hoang
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Daniela Kroshinsky
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
141
|
Alis D, Civcik C, Erol B, Kizilkilic O, Kocer N, Islak C. Flat-detector CT angiography in the evaluation of neuro-Behçet disease. Diagn Interv Imaging 2017. [DOI: 10.1016/j.diii.2017.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
142
|
Falgàs N, Borrego S, Llull L, Espinosa G, López-Rueda A, Blasco J, Cervera A. Recurrent dural arteriovenous fistulas in a patient with Behçet's disease. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
143
|
Fístulas arteriovenosas durales recurrentes en paciente con enfermedad de Behçet. Neurologia 2017; 32:623-626. [DOI: 10.1016/j.nrl.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/19/2015] [Accepted: 11/29/2015] [Indexed: 11/23/2022] Open
|
144
|
Cantini F, Niccoli L, Nannini C, Cassarà E, Kaloudi O. Rapid loss of efficacy of biosimilar infliximab in three patients with Behçet's disease after switching from infliximab originator. Eur J Rheumatol 2017; 4:288-290. [PMID: 29308287 DOI: 10.5152/eurjrheum.2017.16112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/10/2017] [Indexed: 12/26/2022] Open
Abstract
Three patients affected by Behçet's disease (BD) with severe uveitis and neurological involvement in stable clinical remission and who rapidly relapsed after switching from reference infliximab (re-IFX) to biosimilar infliximab (bio-IFX) are reported. In order to observe the rules of local health authorities, two males and one female (38, 26, and 40 years old, respectively) with BD complicated by severe uveitis and neuro-Behçet and who were in prolonged remission, were switched from re-IFX to bio-IFX, with the same dosing regimen of 5 mg/kg intravenous infusions every 8 weeks. All three patients experienced disease flare-ups, with recurrence of uveoretinitis in the first patient, neuro-Behçet in the second, and uveitis and neuro-Behçet in the third after 1, 3, and 2 infusions, respectively. After appropriate washout of re-IFX, all three patients were administered subcutaneous adalimumab, with a dosing regimen of 40 mg/fortnight, and a good response was achieved. Our three patients with BD experienced a rapid disease relapse after switching from re-IFX to bio-IFX, possibly due to cross-reaction of anti-IFX antibodies. This outcome suggests the necessity to exercise caution regarding the automatic substitution of re-IFX with bio-IFX in patients achieving remission with re-IFX.
Collapse
Affiliation(s)
- Fabrizio Cantini
- Division of Rheumatology, Azienda USL Toscana Centro, Hospital of Prato, Italy
| | - Laura Niccoli
- Division of Rheumatology, Azienda USL Toscana Centro, Hospital of Prato, Italy
| | - Carlotta Nannini
- Division of Rheumatology, Azienda USL Toscana Centro, Hospital of Prato, Italy
| | - Emanuele Cassarà
- Division of Rheumatology, Azienda USL Toscana Centro, Hospital of Prato, Italy
| | - Olga Kaloudi
- Division of Rheumatology, Azienda USL Toscana Centro, Hospital of Prato, Italy
| |
Collapse
|
145
|
Liu HM, Dong C, Zhang YZ, Tian YY, Chen HX, Zhang S, Li N, Gu P. Clinical and imaging features of spinal cord type of neuro Behçet disease: A case report and systematic review. Medicine (Baltimore) 2017; 96:e7958. [PMID: 28984755 PMCID: PMC5737991 DOI: 10.1097/md.0000000000007958] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 01/20/2023] Open
Abstract
RATIONAL To investigate the clinical and MRI characteristics of spinal cord nerve Behçet's disease. PATIENT CONCERNS One patient with spinal cord nerve Behçet's disease was admitted to our hospital at October 20, 2015. DIAGNOSE Spinal cord nerve Behçet's disease. INTERVENTIONS Retrospective analysis was performed on such case as well as 16 cases of spinal cord nerve Behçet's disease reported in China or abroad. OUTCOMES Seventeen cases of spinal cord type of neuro Behçet's disease include 13 men and 4 women, with an average age of onset of 34.8 years old. The mean time from Behçet's disease symptoms to spinal cord involvement were 10.8 years. The initial symptom in one case was spinal cord injury, and another 4 cases had a recurrence course. The most common performance of spinal cord injury was sensory disturbance (82.4%), following by weakness (76.5%), sphincter or sexual dysfunction (58.8%), and pain in back, backside of neck or lower chest (29.4%). The number of cells was slightly increased or the protein level was increased in cerebrospinal fluid test. And the water channel protein antibody and oligoclonal band of serum levels were all negative. The spinal cord injury involved more than 3 vertebral bodies in 10 cases, and involved more than half of spinal cord in sagittal plane in 8 cases. In acute stage, shock therapy with large dose of glucocorticoid was generally applied both in China and abroad. LESSONS The clinical features of spinal cord nerve Behçet's disease were various, making it easily misdiagnosed. Longitudinal extensive transverse myelitis performs as a characteristic manifestation.
Collapse
Affiliation(s)
- Hui-Miao Liu
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Ci Dong
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Yong-Zhi Zhang
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Ya-Yun Tian
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Hong-Xu Chen
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Sai Zhang
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Na Li
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Ping Gu
- Department of Neurology, the First Hospital of Hebei Medical University
- Brain Ageing and Cognitive Neuroscience Laboratory of Hebei, Shijiazhuang, Hebei, China
| |
Collapse
|
146
|
Cohen-Aubart F, Psimaras D, Galanaud D, Bielle F, Touitou V, Haroche J, Amoura Z. Cerebral pseudo-tumoral neuro-Behcet: Histological demonstration of an inflammatory and vascular disease. Clin Neurol Neurosurg 2017; 161:48-50. [DOI: 10.1016/j.clineuro.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
|
147
|
Volle G, Fraison JB, Gobert D, Goulenok T, Dhote R, Fain O, Gonzalez-Chiappe S, Lhote F, Papo T, Thuillier A, Rivière S, Mahr A. Dietary and Nondietary Triggers of Oral Ulcer Recurrences in Behçet's Disease. Arthritis Care Res (Hoboken) 2017; 69:1429-1436. [PMID: 27863145 DOI: 10.1002/acr.23155] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/01/2016] [Accepted: 11/15/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The nature and impact of food and other external triggers in recurrences of Behçet's disease (BD)-related oral ulcers (OUs) remain unknown. This survey investigated dietary and nondietary triggers of BD-related OU recurrences. METHODS Patients with BD who were followed in 7 French hospital departments completed a self-administered patient questionnaire. General and specific dietary triggering factors were sought in open questions. The questionnaire also included closed questions, notably to evaluate the effect of 6 general triggering situations and 24 selected foods. The results were expressed as number (percentage) of positive responses. RESULTS Among the 101 questionnaires distributed, 81 were usable. Among the 81 patients, 96% fulfilled the International Criteria for Behçet's Disease classification criteria, and 53% qualified their OU recurrences during the previous 12 months as very discomforting or discomforting. For the 6 general situations suggested, 50 patients (62%) declared ≥1 as a "sure" trigger of OU recurrences. In both open and closed questions, the most frequent triggers were fatigue/stress (37-47% of patients) and food (32-35%). Among the 24 suggested foods, nuts (48%), pineapple (42%), peanuts (32%), Emmental cheese (30%), almonds (23%), lemons (22%), and other cheeses (21%) were the most frequently reported. The corresponding open question gave consistent findings but with lower frequencies. CONCLUSION Most patients can identify triggers of recurring BD-related OUs, with fatigue/stress and food representing the most frequent triggers. The management of OU must consider such external factors. The histamine-rich or -liberating properties of the commonly cited OU-triggering foods suggest a hyperreactivity mechanism.
Collapse
Affiliation(s)
- Geoffroy Volle
- Hospital Saint-Louis, University Paris Diderot, Paris, France
| | - Jean-Baptiste Fraison
- Hospital Saint-Louis, University Paris Diderot, Paris, and Hospital Jean Verdier, University Leonard de Vinci, Bondy, France
| | - Delphine Gobert
- Hospital Saint Antoine, University Pierre et Marie Curie, Paris, France
| | | | - Robin Dhote
- Hospital Avicenne, University Leonard de Vinci, Bobigny, France
| | - Olivier Fain
- Hospital Saint Antoine, University Pierre et Marie Curie, Paris, France
| | | | | | - Thomas Papo
- Hospital Bichat, University Paris Diderot, Paris, France
| | | | - Sophie Rivière
- Hospital Saint-Eloi, University Montpellier, Montpellier, France
| | - Alfred Mahr
- Hospital Saint-Louis, University Paris Diderot, and Sorbonne Paris Cité Research Center UMR 1153, Inserm, Paris, France
| |
Collapse
|
148
|
Knitting the Threads of Silk through Time: Behçet's Disease-Past, Present, and Future. Int J Rheumatol 2017; 2017:2160610. [PMID: 29081805 PMCID: PMC5610876 DOI: 10.1155/2017/2160610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/07/2017] [Indexed: 12/14/2022] Open
Abstract
Behçet's disease (BD) is a chronic relapsing vasculitis that affects vessels of all types and sizes with a broad spectrum of phenotypic heterogeneity and complex immunopathogenesis. Efforts by the scientific community to resolve the unmet needs of BD and gaps in our knowledge have been hampered by considerable challenges that primarily relate to the rare nature of the disease in many parts of the world and its heterogeneity. Controversies remain in many aspects of the disease including the diagnostic criteria, immunopathogenesis and biomarker discovery, geographical variation, and therapeutic considerations. In this review, we highlight recent advances in our scientific understanding of BD, shed new insights into diagnostic and treatment strategies, and discuss residual gaps in our knowledge that will serve as the basis for current and future research.
Collapse
|
149
|
Ishido M, Horita N, Takeuchi M, Shibuya E, Yamane T, Kawagoe T, Ishido T, Minegishi K, Yoshimi R, Kirino Y, Hirohata S, Ishigatsubo Y, Takeno M, Kaneko T, Mizuki N. Distinct clinical features between acute and chronic progressive parenchymal neuro-Behçet disease: meta-analysis. Sci Rep 2017; 7:10196. [PMID: 28860590 PMCID: PMC5579041 DOI: 10.1038/s41598-017-09938-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/01/2017] [Indexed: 01/18/2023] Open
Abstract
Neuro-Behçet’s disease (NBD) is subcategorized into parenchymal-NBD (P-NBD) and non-parenchymal-NBD types. Recently, P-NBD has been further subdivided into acute P-NBD (A-P-NBD) and chronic progressive P-NBD (CP-P-NBD). Although an increasing number of studies have reported the various clinical features of A-P-NBD and CP-P-NBD over the last two decades, there was a considerable inconsistency. Two investigators systematically searched four electrical databases to detect studies that provided sufficient data to assess the specific characteristics of A-P-NBD and CP-P-NBD. All meta-analysis was carried out by employing the random-model generic inverse variance method. We included 11 reports consisted of 184 A-P-NBD patients and 114 CP-P-NBD patients. While fever (42% for A-P-NBD, 5% for CP-P-NBD, p < 0.001, I2 = 93%) was more frequently observed in A-P-NBD cases; sphincter disturbances (9%, 34%, P = 0.005, I2 = 87%), ataxia (16%, 57%, P < 0.001, I2 = 92%), dementia (7%, 61%, P < 0.001, I2 = 97%), confusion (5%, 18%, P = 0.04, I2 = 76%), brain stem atrophy on MRI (4%, 75%, P < 0.001, I2 = 98%), and abnormal MRI findings in cerebellum (7%, 54%, P = 0.02, I2 = 81%) were more common in CP-P-NBD. Cerebrospinal fluid cell count (94/mm3, 11/mm3, P = 0.009, I2 = 85%) was higher in A-P-NBD cases. We demonstrated that A-P-NBD and CP-P-NBD had clearly different clinical features and believe that these data will help future studies investigating P-NBD.
Collapse
Affiliation(s)
- Mizuho Ishido
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Etsuko Shibuya
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takahiro Yamane
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tatsukata Kawagoe
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takehito Ishido
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kaoru Minegishi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shunsei Hirohata
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | | | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
150
|
Shi J, Huang X, Li G, Wang L, Liu J, Xu Y, Zeng X, Zheng W. Cerebral venous sinus thrombosis in Behçet’s disease: a retrospective case-control study. Clin Rheumatol 2017; 37:51-57. [DOI: 10.1007/s10067-017-3718-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/03/2017] [Accepted: 05/31/2017] [Indexed: 12/14/2022]
|