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Borhani-Haghighi A, Kardeh B, Banerjee S, Yadollahikhales G, Safari A, Sahraian MA, Shapiro L. Neuro-Behcet's disease: An update on diagnosis, differential diagnoses, and treatment. Mult Scler Relat Disord 2019; 39:101906. [PMID: 31887565 DOI: 10.1016/j.msard.2019.101906] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 12/17/2019] [Accepted: 12/21/2019] [Indexed: 02/08/2023]
Abstract
Neuro-Behcet's disease (NBD) is defined as a combination of neurologic symptoms and/or signs in a patient with Behcet's disease (BD). Relevant syndromes include brainstem syndrome, multiple-sclerosis like presentations, movement disorders, meningoencephalitic syndrome, myelopathic syndrome, cerebral venous sinus thrombosis (CVST), and intracranial hypertension. Central nervous involvement falls into parenchymal and non-parenchymal subtypes. The parenchymal type is more prevalent and presents as brainstem, hemispheric, spinal, and meningoencephalitic manifestations. Non-parenchymal type includes CVST and arterial involvement. Perivascular infiltration of polymorphonuclear and mononuclear cells is seen in most histo-pathologic reports. In parenchymal NBD, cerebrospinal fluid (CSF) generally exhibits pleocytosis, increased protein and normal glucose. In NBD and CVST, CSF pressure is increased but content is usually normal. The typical acute NBD lesions in brain magnetic resonance imaging (MRI) are mesodiencephalic lesions. The pattern of extension from thalamus to midbrain provides a cascade sign. Brain MRI in chronic NBD usually shows brain or brainstem atrophy and/or black holes. The spinal MRI in the acute or subacute myelopathies reveals noncontiguous multifocal lesions mostly in cervical and thoracic lesions. In chronic patients, cord atrophy can also be seen. Brain MRI (particularly susceptibility-weighted images), MR venography (MRV) and computerized tomographic venography (CTV) can be used to diagnose CVST. Parenchymal NBD attacks can be treated with glucocorticoids alone or in combination with azathioprine. For patients with relapsing-remitting or progressive courses, shifting to more potent immunosuppressive drugs such as mycophenolate, methotrexate, cyclophosphamide, or targeted therapy is warranted. For NBD and CVST, immunosuppressive drugs with or without anticoagulation are suggested.
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Affiliation(s)
| | - Bahareh Kardeh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shubhasree Banerjee
- Division of Rheumatology, Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anahid Safari
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences Shiraz, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical sciences, Tehran, Iran
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Venkatesan A, Chow FC, Aksamit A, Bartt R, Bleck TP, Jay C, Pastula DM, Roos KL, Rumbaugh J, Saylor D, Cho TA. Building a neuroinfectious disease consensus curriculum. Neurology 2019; 93:208-216. [PMID: 31253643 DOI: 10.1212/wnl.0000000000007872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/03/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To delineate a comprehensive curriculum for fellowship training in neuroinfectious diseases, we conducted a modified Delphi approach to reach consensus among 11 experts in the field. METHODS The authors invited a diverse range of experts from the American Academy of Neurology Neuro-Infectious Diseases (AAN Neuro-ID) Section to participate in a consensus process using a modified Delphi technique. RESULTS A comprehensive list of topics was generated with 101 initial items. Through 3 rounds of voting and discussion, a curriculum with 83 items reached consensus. CONCLUSIONS The modified Delphi technique provides an efficient and rigorous means to reach consensus on topics requiring expert opinion. The AAN Neuro-ID section provided the pool of diverse experts, the infrastructure, and the community through which to accomplish the consensus project successfully. This process could be applied to other subspecialties and sections at the AAN.
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Affiliation(s)
- Arun Venkatesan
- From the Neuro-Infectious Diseases Section (A.V., F.C.C., A.A., R.B., T.P.B., C.J., D.M.P., K.L.R., J.R., D.S., T.A.C.), American Academy of Neurology, Minneapolis, MN; Johns Hopkins University (A.V., D.S.), Baltimore, MD; University of California (F.C.C., C.J.), San Francisco; Mayo Clinic (A.A.), Rochester, MN; Blue Sky Neurology (R.B.), Englewood, CO; Rush Medical College (T.P.B.), Chicago; University of Colorado and Colorado School of Public Health (D.M.P.), Aurora; Indiana University (K.R.), Indianapolis; Remyelix Neurology & Multiple Sclerosis Institute (J.R.), Tampa, FL; University of Iowa (T.A.C.), Iowa City
| | - Felicia C Chow
- From the Neuro-Infectious Diseases Section (A.V., F.C.C., A.A., R.B., T.P.B., C.J., D.M.P., K.L.R., J.R., D.S., T.A.C.), American Academy of Neurology, Minneapolis, MN; Johns Hopkins University (A.V., D.S.), Baltimore, MD; University of California (F.C.C., C.J.), San Francisco; Mayo Clinic (A.A.), Rochester, MN; Blue Sky Neurology (R.B.), Englewood, CO; Rush Medical College (T.P.B.), Chicago; University of Colorado and Colorado School of Public Health (D.M.P.), Aurora; Indiana University (K.R.), Indianapolis; Remyelix Neurology & Multiple Sclerosis Institute (J.R.), Tampa, FL; University of Iowa (T.A.C.), Iowa City
| | - Allen Aksamit
- From the Neuro-Infectious Diseases Section (A.V., F.C.C., A.A., R.B., T.P.B., C.J., D.M.P., K.L.R., J.R., D.S., T.A.C.), American Academy of Neurology, Minneapolis, MN; Johns Hopkins University (A.V., D.S.), Baltimore, MD; University of California (F.C.C., C.J.), San Francisco; Mayo Clinic (A.A.), Rochester, MN; Blue Sky Neurology (R.B.), Englewood, CO; Rush Medical College (T.P.B.), Chicago; University of Colorado and Colorado School of Public Health (D.M.P.), Aurora; Indiana University (K.R.), Indianapolis; Remyelix Neurology & Multiple Sclerosis Institute (J.R.), Tampa, FL; University of Iowa (T.A.C.), Iowa City
| | - Russell Bartt
- From the Neuro-Infectious Diseases Section (A.V., F.C.C., A.A., R.B., T.P.B., C.J., D.M.P., K.L.R., J.R., D.S., T.A.C.), American Academy of Neurology, Minneapolis, MN; Johns Hopkins University (A.V., D.S.), Baltimore, MD; University of California (F.C.C., C.J.), San Francisco; Mayo Clinic (A.A.), Rochester, MN; Blue Sky Neurology (R.B.), Englewood, CO; Rush Medical College (T.P.B.), Chicago; University of Colorado and Colorado School of Public Health (D.M.P.), Aurora; Indiana University (K.R.), Indianapolis; Remyelix Neurology & Multiple Sclerosis Institute (J.R.), Tampa, FL; University of Iowa (T.A.C.), Iowa City
| | - Thomas P Bleck
- From the Neuro-Infectious Diseases Section (A.V., F.C.C., A.A., R.B., T.P.B., C.J., D.M.P., K.L.R., J.R., D.S., T.A.C.), American Academy of Neurology, Minneapolis, MN; Johns Hopkins University (A.V., D.S.), Baltimore, MD; University of California (F.C.C., C.J.), San Francisco; Mayo Clinic (A.A.), Rochester, MN; Blue Sky Neurology (R.B.), Englewood, CO; Rush Medical College (T.P.B.), Chicago; University of Colorado and Colorado School of Public Health (D.M.P.), Aurora; Indiana University (K.R.), Indianapolis; Remyelix Neurology & Multiple Sclerosis Institute (J.R.), Tampa, FL; University of Iowa (T.A.C.), Iowa City
| | - Cheryl Jay
- From the Neuro-Infectious Diseases Section (A.V., F.C.C., A.A., R.B., T.P.B., C.J., D.M.P., K.L.R., J.R., D.S., T.A.C.), American Academy of Neurology, Minneapolis, MN; Johns Hopkins University (A.V., D.S.), Baltimore, MD; University of California (F.C.C., C.J.), San Francisco; Mayo Clinic (A.A.), Rochester, MN; Blue Sky Neurology (R.B.), Englewood, CO; Rush Medical College (T.P.B.), Chicago; University of Colorado and Colorado School of Public Health (D.M.P.), Aurora; Indiana University (K.R.), Indianapolis; Remyelix Neurology & Multiple Sclerosis Institute (J.R.), Tampa, FL; University of Iowa (T.A.C.), Iowa City
| | - Daniel M Pastula
- From the Neuro-Infectious Diseases Section (A.V., F.C.C., A.A., R.B., T.P.B., C.J., D.M.P., K.L.R., J.R., D.S., T.A.C.), American Academy of Neurology, Minneapolis, MN; Johns Hopkins University (A.V., D.S.), Baltimore, MD; University of California (F.C.C., C.J.), San Francisco; Mayo Clinic (A.A.), Rochester, MN; Blue Sky Neurology (R.B.), Englewood, CO; Rush Medical College (T.P.B.), Chicago; University of Colorado and Colorado School of Public Health (D.M.P.), Aurora; Indiana University (K.R.), Indianapolis; Remyelix Neurology & Multiple Sclerosis Institute (J.R.), Tampa, FL; University of Iowa (T.A.C.), Iowa City
| | - Karen L Roos
- From the Neuro-Infectious Diseases Section (A.V., F.C.C., A.A., R.B., T.P.B., C.J., D.M.P., K.L.R., J.R., D.S., T.A.C.), American Academy of Neurology, Minneapolis, MN; Johns Hopkins University (A.V., D.S.), Baltimore, MD; University of California (F.C.C., C.J.), San Francisco; Mayo Clinic (A.A.), Rochester, MN; Blue Sky Neurology (R.B.), Englewood, CO; Rush Medical College (T.P.B.), Chicago; University of Colorado and Colorado School of Public Health (D.M.P.), Aurora; Indiana University (K.R.), Indianapolis; Remyelix Neurology & Multiple Sclerosis Institute (J.R.), Tampa, FL; University of Iowa (T.A.C.), Iowa City
| | - Jeffrey Rumbaugh
- From the Neuro-Infectious Diseases Section (A.V., F.C.C., A.A., R.B., T.P.B., C.J., D.M.P., K.L.R., J.R., D.S., T.A.C.), American Academy of Neurology, Minneapolis, MN; Johns Hopkins University (A.V., D.S.), Baltimore, MD; University of California (F.C.C., C.J.), San Francisco; Mayo Clinic (A.A.), Rochester, MN; Blue Sky Neurology (R.B.), Englewood, CO; Rush Medical College (T.P.B.), Chicago; University of Colorado and Colorado School of Public Health (D.M.P.), Aurora; Indiana University (K.R.), Indianapolis; Remyelix Neurology & Multiple Sclerosis Institute (J.R.), Tampa, FL; University of Iowa (T.A.C.), Iowa City
| | - Deanna Saylor
- From the Neuro-Infectious Diseases Section (A.V., F.C.C., A.A., R.B., T.P.B., C.J., D.M.P., K.L.R., J.R., D.S., T.A.C.), American Academy of Neurology, Minneapolis, MN; Johns Hopkins University (A.V., D.S.), Baltimore, MD; University of California (F.C.C., C.J.), San Francisco; Mayo Clinic (A.A.), Rochester, MN; Blue Sky Neurology (R.B.), Englewood, CO; Rush Medical College (T.P.B.), Chicago; University of Colorado and Colorado School of Public Health (D.M.P.), Aurora; Indiana University (K.R.), Indianapolis; Remyelix Neurology & Multiple Sclerosis Institute (J.R.), Tampa, FL; University of Iowa (T.A.C.), Iowa City
| | - Tracey A Cho
- From the Neuro-Infectious Diseases Section (A.V., F.C.C., A.A., R.B., T.P.B., C.J., D.M.P., K.L.R., J.R., D.S., T.A.C.), American Academy of Neurology, Minneapolis, MN; Johns Hopkins University (A.V., D.S.), Baltimore, MD; University of California (F.C.C., C.J.), San Francisco; Mayo Clinic (A.A.), Rochester, MN; Blue Sky Neurology (R.B.), Englewood, CO; Rush Medical College (T.P.B.), Chicago; University of Colorado and Colorado School of Public Health (D.M.P.), Aurora; Indiana University (K.R.), Indianapolis; Remyelix Neurology & Multiple Sclerosis Institute (J.R.), Tampa, FL; University of Iowa (T.A.C.), Iowa City.
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