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Hadj Taieb MA, Slimane H, Mhiri M, Ben Dhia R, Daoussi N, Frih-Ayed M. Pseudotumoral neuro-behcet's disease: case series and review of literature. Acta Neurol Belg 2024; 124:431-445. [PMID: 38396190 DOI: 10.1007/s13760-024-02477-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/03/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Behcet's disease (BD) is a multisystem autoimmune relapsing vasculitis with an almost unknown etiology involving both large and small vessels. The neurological involvement called neuro-Behcet's disease (NBD) is rare. NBD can be responsible for tumor-like masses mimicking low-grade gliomas in only a few cases. METHODS We report here the main characteristics, treatment, and outcome of 43 patients (4 personal cases and 39 patients from the literature) with a pseudotumoral presentation of NBD (PT NBD). We compared our findings with those of the classical form of NBD. RESULTS The median age was 35.86 (12-59 years) years, with a male predominance (67.4%). PT NBD was the inaugural of the disease in 51.2% of cases. The neurological manifestations included headache (n = 31), pyramidal syndrome (n = 28), cerebellar syndrome (n = 5), behavioral changes (n = 5), and pseudobulbar signs (n = 2). Ophthalmologic examination revealed papilledema in 3 cases. On cerebral imaging, the most affected regions of the brain were the capsulothalamic region (n = 15, 37.5%) and the brainstem (n = 14, 35). Histological analysis revealed necrotic lesions with perivascular inflammatory infiltrate without signs of tumoral or infectious lesions. Treatment consisted of corticosteroids (n = 40, 93%) and immunosuppressive agents (n = 28, 65.11%), leading to complete clinical and imaging remission in 41.5% of patients. CONCLUSION PT NBD is a rare but life-threatening condition.
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Affiliation(s)
| | - Houssem Slimane
- Neurology department, Fatouma Bourguiba Hospital, Monastir, Tunisia
| | - Mariem Mhiri
- Neurology department, Fatouma Bourguiba Hospital, Monastir, Tunisia
| | - Rihab Ben Dhia
- Neurology department, Fatouma Bourguiba Hospital, Monastir, Tunisia
| | - Nizar Daoussi
- Neurology department, Fatouma Bourguiba Hospital, Monastir, Tunisia
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Lim M, Archambeaud A, Ferreira-Maldent N, Cottier JP, Samimi M. Pseudotumoral presentation of neuro-Behçet's disease in a patient receiving apremilast: A precipitating agent? Ann Dermatol Venereol 2024; 151:103251. [PMID: 38417200 DOI: 10.1016/j.annder.2024.103251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/31/2023] [Accepted: 01/08/2024] [Indexed: 03/01/2024]
Affiliation(s)
- M Lim
- Department of Dermatology, University Hospital Center of Tours, Tours, France
| | - A Archambeaud
- Department of Internal Medicine, University Hospital Center of Tours, Tours, France
| | - N Ferreira-Maldent
- Department of Internal Medicine, University Hospital Center of Tours, Tours, France
| | - J-P Cottier
- Department of Neuroradiology, University Hospital Center of Tours, Tours, France
| | - M Samimi
- Department of Dermatology, University Hospital Center of Tours, Tours, France.
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3
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Kidd DP. Neurological involvement by Behçet's syndrome: clinical features, diagnosis, treatment and outcome. Pract Neurol 2023; 23:386-400. [PMID: 37775123 DOI: 10.1136/pn-2023-003875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Abstract
Neurological involvement in Behçet's syndrome arises predominately through an inflammatory meningoencephalitis characterised by perivenular inflammation due to activation of Th-17 immunological pathways. The brainstem is involved in 50% of cases, the diencephalon and other areas of the brain in 30%, and the spinal cord in 10%. Movement disorders and epilepsy may occur. Psychiatric syndromes may arise with brain and brainstem involvement, and cognitive disorders relate to the brain disease, to circulating inflammatory factors, and to fatigue and despondency. Eighty per cent of cases begin with a relapsing disease course, of whom 70% have only one attack, and 30% have a progressive disease course either from onset or following an initially relapsing course. Venous thrombosis leading to intracranial hypertension and cerebral venous infarction is less common and caused by inflammation in affected veins and a circulating prothrombotic state. Arterial involvement is rare and relates to an arteritis affecting large-sized and medium-sized vessels within the brain leading to infarction, subarachnoid and parenchymal haemorrhage, aneurysm formation and arterial dissection. There is a newly recognised disorder of cerebral cortical hypoperfusion. Cranial neuropathy, peripheral neuropathy and myositis are rare. There has been significant progress in understanding the pathophysiology and treatment of the systemic disease, leading to improved outcomes, but there has been no randomised trial of treatment in the neurological disorder.
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Yong HYF, Camara-Lemarroy CR, Alikhani K. Neuro-Behcet's Presenting as a Tumefactive Brainstem Mass. Can J Neurol Sci 2023; 50:787-789. [PMID: 36184885 DOI: 10.1017/cjn.2022.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Heather Y F Yong
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carlos R Camara-Lemarroy
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Katayoun Alikhani
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Grand S, Nedunchelian M, Charara S, Demaison R, Jean C, Galloux A, Kastler A, Attye A, Berthet C, Krainik A. Tumor or not a tumor: Pitfalls and differential diagnosis in neuro-oncology. Rev Neurol (Paris) 2023; 179:378-393. [PMID: 37030987 DOI: 10.1016/j.neurol.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/08/2023]
Abstract
The majority of intracranial expansive lesions are tumors. However, a wide range of lesions can mimic neoplastic pathology. Differentiating pseudotumoral lesions from brain tumors is crucial to patient management. This article describes the most common intracranial pseudotumors, with a focus on the imaging features that serve as clues to detect pseudotumors.
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6
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Pseudo-tumour lesion of the brainstem: A case and discussion. Rev Neurol (Paris) 2022; 178:983-985. [DOI: 10.1016/j.neurol.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 07/19/2022] [Indexed: 11/05/2022]
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7
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Rubenstein E, Amador-Borrero B, Lazureanu P, Kladoum N, Lopes A, Champion K, Comarmond C, Mouly S, Sene D. Hypothermie paroxystique dans une forme pseudotumorale de neuro-Behçet. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Kone-Paut I, Barete S, Bodaghi B, Deiva K, Desbois AC, Galeotti C, Gaudric J, Kaplanski G, Mahr A, Noel N, Piram M, Tran TA, Wechsler B, Saadoun D. French recommendations for the management of Behçet's disease. Orphanet J Rare Dis 2021; 16:352. [PMID: 33622338 PMCID: PMC7903591 DOI: 10.1186/s13023-020-01620-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Behçet's disease (BD) is a systemic variable vessel vasculitis that involves the skin, mucosa, joints, eyes, arteries, veins, nervous system and gastrointestinal system, presenting with remissions and exacerbations. It is a multifactorial disease, and several triggering factors including oral cavity infections and viruses may induce inflammatory attacks in genetically susceptible individuals. BD vasculitis involves different vessel types and sizes of the vascular tree with mixed-cellular perivascular infiltrates and is often complicated by recurrent thrombosis, particularly in the venous compartment. Several new therapeutic modalities with different mechanisms of action have been studied in patients with BD. A substantial amount of new data have been published on the management of BD, especially with biologics, over the last years. These important therapeutic advances in BD have led us to propose French recommendations for the management of Behçet's disease [Protocole National de Diagnostic et de Soins de la maladie de Behçet (PNDS)]. These recommendations are divided into two parts: (1) the diagnostic process and initial assessment; (2) the therapeutic management. Thirty key points summarize the essence of the recommendations. We highlighted the main differential diagnosis of BD according to the type of clinical involvement; the role of genetics is also discussed, and we indicate the clinical presentations that must lead to the search for a genetic cause.
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Affiliation(s)
- Isabelle Kone-Paut
- Pediatric Rheumatology and CEREMAIA, Bicêtre Hospital APHP, University of Paris Sud Saclay, Le Kremlin-Bicêtre, France.
| | - Stéphane Barete
- Unit of Dermatology, DMU3ID, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), INSERM-UMRS 959, Sorbonne Universités, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, CRMR OPHTARA, IHU FOReSIGHT, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
| | - Kumaran Deiva
- Department of Pediatric Neurology, National Referral Center for Rare Inflammatory Brain and Spinal Diseases, Assistance Publique-Hopitaux de Paris, University Hospitals of Paris-Saclay, Bicêtre Hospital, Paris, France
- Inserm UMR1184, Immunology of Viral Infections and Autoimmune Diseases, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Anne-Claire Desbois
- UPMC Université Paris 06, Inserm UMR S 959, Immunology Immunopathology Immunotherapy (I3), Sorbonne Universités, 75005, Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, 75651, Paris, France
- AP-HP groupe hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, centre national de référence maladies autoinflammatoires et amylose inflammatoire, centre national de références maladies autoimmunes systémiques rares, 75013, Paris, France
| | - Caroline Galeotti
- Pediatric Rheumatology and CEREMAIA, Bicêtre Hospital APHP, University of Paris Sud Saclay, Le Kremlin-Bicêtre, France
| | - Julien Gaudric
- Department of Vascular Surgery, Pitié-Salpétrière Hospital, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Gilles Kaplanski
- Internal Medicine and Clinical Immunology Department, Hôpital de la Conception, Aix-Marseille Université, Marseille, France
| | - Alfred Mahr
- Clinic for Rheumatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Nicolas Noel
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, CHU Bicêtre, Le Kremlin Bicêtre, France
- INSERM, UMR 1184, Immunologie des Maladies Virales et Autoimmunes, Université Paris Saclay, Le Kremlin Bicêtre, France
- CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Fontenay aux Roses, France
| | - Maryam Piram
- Pediatric Rheumatology and CEREMAIA, Bicêtre Hospital APHP, University of Paris Sud Saclay, Le Kremlin-Bicêtre, France
- Pediatric Dermatology, CHU Sainte Justine Research Centre, CHU Sainte Justine, University of Montreal, Montreal, Canada
| | - Tu-Anh Tran
- Department of Pediatrics, Nîmes University Hospital, INSERM U1183, Montpellier-Nîmes University, Nîmes, France
| | - Bertrand Wechsler
- UPMC Université Paris 06, Inserm UMR S 959, Immunology Immunopathology Immunotherapy (I3), Sorbonne Universités, 75005, Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, 75651, Paris, France
- AP-HP groupe hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, centre national de référence maladies autoinflammatoires et amylose inflammatoire, centre national de références maladies autoimmunes systémiques rares, 75013, Paris, France
| | - David Saadoun
- UPMC Université Paris 06, Inserm UMR S 959, Immunology Immunopathology Immunotherapy (I3), Sorbonne Universités, 75005, Paris, France.
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, 75651, Paris, France.
- AP-HP groupe hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, centre national de référence maladies autoinflammatoires et amylose inflammatoire, centre national de références maladies autoimmunes systémiques rares, 75013, Paris, France.
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Gray BR, Agarwal A, Tann M, Koontz NA. PET and SPECT Imaging of Brain Neoplasia Mimics. Semin Ultrasound CT MR 2020; 41:541-550. [DOI: 10.1053/j.sult.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Law LY, Riminton DS, Nguyen M, Barnett MH, Reddel SW, Hardy TA. The spectrum of immune-mediated and inflammatory lesions of the brainstem: Clues to diagnosis. Neurology 2020; 93:390-405. [PMID: 31451586 DOI: 10.1212/wnl.0000000000008015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/29/2019] [Indexed: 11/15/2022] Open
Abstract
The presentation of a patient with brainstem symptoms and signs invokes a number of common and less common differential diagnoses, and accurate diagnosis can be challenging. We review the major immune-mediated and inflammatory syndromes that can affect the brainstem including multiple sclerosis, neuromyelitis optica spectrum disorder, neuro-Behçet disease, chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids, neurosarcoidosis, Susac syndrome, and the histiocytic disorders. We focus on clinical features and MRI clues that help to distinguish among the different brainstem conditions. Accurate diagnosis is important to guide appropriate treatment and limit neurologic disability.
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Affiliation(s)
- Lai Yin Law
- From the Neuroimmunology Clinic, Concord Hospital (L.Y.L., D.S.R., M.N., S.W.R., T.A.H.), Brain and Mind Centre (M.H.B., S.W.R., T.A.H.), and Department of Neurology, Royal Prince Alfred Hospital (M.H.B.), University of Sydney, NSW, Australia
| | - D Sean Riminton
- From the Neuroimmunology Clinic, Concord Hospital (L.Y.L., D.S.R., M.N., S.W.R., T.A.H.), Brain and Mind Centre (M.H.B., S.W.R., T.A.H.), and Department of Neurology, Royal Prince Alfred Hospital (M.H.B.), University of Sydney, NSW, Australia
| | - MaiAnh Nguyen
- From the Neuroimmunology Clinic, Concord Hospital (L.Y.L., D.S.R., M.N., S.W.R., T.A.H.), Brain and Mind Centre (M.H.B., S.W.R., T.A.H.), and Department of Neurology, Royal Prince Alfred Hospital (M.H.B.), University of Sydney, NSW, Australia
| | - Michael H Barnett
- From the Neuroimmunology Clinic, Concord Hospital (L.Y.L., D.S.R., M.N., S.W.R., T.A.H.), Brain and Mind Centre (M.H.B., S.W.R., T.A.H.), and Department of Neurology, Royal Prince Alfred Hospital (M.H.B.), University of Sydney, NSW, Australia
| | - Stephen W Reddel
- From the Neuroimmunology Clinic, Concord Hospital (L.Y.L., D.S.R., M.N., S.W.R., T.A.H.), Brain and Mind Centre (M.H.B., S.W.R., T.A.H.), and Department of Neurology, Royal Prince Alfred Hospital (M.H.B.), University of Sydney, NSW, Australia
| | - Todd A Hardy
- From the Neuroimmunology Clinic, Concord Hospital (L.Y.L., D.S.R., M.N., S.W.R., T.A.H.), Brain and Mind Centre (M.H.B., S.W.R., T.A.H.), and Department of Neurology, Royal Prince Alfred Hospital (M.H.B.), University of Sydney, NSW, Australia.
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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: 46] [Impact Index Per Article: 9.2] [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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Li S, Garg G, Goyal B, Abdelbaki A, Hegde R, Kumar A, Rosovsky M. Rhombencephalitis in cocaine-induced nasal septal perforation and skull base erosion. Proc (Bayl Univ Med Cent) 2019; 32:82-84. [PMID: 30956592 DOI: 10.1080/08998280.2018.1536586] [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: 07/27/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 12/30/2022] Open
Abstract
Rhombencephalitis is a rare and potentially fatal condition involving the brainstem, with infectious, autoimmune, and paraneoplastic etiologies. We present a patient presenting with left-extremity weakness and dysphonia who had brainstem imaging findings suggestive of rhombencephalitis. We suspect that the case was due to inoculation of the brainstem from nasopharyngeal adenoviral infection. Due to heavy cocaine use, extensive basiocciput erosion led to direct contact between the brainstem and the nasopharyngeal mucosa. The patient's milder clinical course might have been due to some degree of pre-existing immunity against adenovirus. Additionally, clinicians need to be aware of the proximity of the brainstem to the nasopharynx when there is basiocciput erosion, due to the potential risk of injury during instrumentation.
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Affiliation(s)
- Shuo Li
- Department of Interventional Radiology, University of Miami/Jackson Memorial HospitalMiamiFlorida
| | - Gunjan Garg
- Department of Radiology, Yale New Haven Health Bridgeport HospitalBridgeportConnecticut
| | - Bobby Goyal
- Department of Physiology and Neuroscience, St. George's University School of MedicineGreat RiverNew York
| | - Ahmed Abdelbaki
- Department of Radiology, Yale New Haven Health Bridgeport HospitalBridgeportConnecticut
| | - Rahul Hegde
- Department of Radiology, Yale New Haven Health Bridgeport HospitalBridgeportConnecticut
| | - Anil Kumar
- Department of Neurology, Great Plains HealthNorth PlatteNebraska
| | - Mark Rosovsky
- Department of Radiology, Yale New Haven Health Bridgeport HospitalBridgeportConnecticut
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Paschalis T, Shami NM, Mandal AK, Missouris CG. Neuro-Behçet's masquerading as progressive bulbar palsy: a case report and literature review. JRSM Open 2019; 10:2054270419834841. [PMID: 30937175 PMCID: PMC6434437 DOI: 10.1177/2054270419834841] [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] [Indexed: 11/17/2022] Open
Abstract
In patients with progressive bulbar palsy without an obvious cause, there should be a high index of suspicion for the potential diagnosis of Neuro-Behçet’s Disease, even in the absence of the acute classical peripheral manifestations of Bechet’s Disease, with emphasis in prompt diagnosis using ‘The International Criteria for Behçet’s Disease’ and rapid, effective treatment in order to improve outcome.
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Affiliation(s)
- Theodoros Paschalis
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SP, UK
| | - Noor M Shami
- Department of Medicine, St George's Medical School, Nicosia, 2408, Cyprus
| | - Amit Kj Mandal
- Departments of Medicine and Cardiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, SL2 4HL, UK
| | - Constantinos G Missouris
- Departments of Medicine and Cardiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, SL2 4HL, UK.,Departments of Medicine and Clinical Cardiology, University of Cyprus Medical School, Nicosia, 2029, Cyprus
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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.
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Alghamdi A, Bodaghi B, Comarmond C, Desbois AC, Domont F, Wechsler B, Depaz R, Le Hoang P, Cacoub P, Touitou V, Saadoun D. Neuro-ophthalmological manifestations of Behçet's disease. Br J Ophthalmol 2018; 103:83-87. [PMID: 29699980 DOI: 10.1136/bjophthalmol-2017-311334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 03/11/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND The neuro-ophthalmological manifestations of Behcet's disease (BD) are rare, and data regarding their characteristics and outcome are lacking. OBJECTIVE To report prevalence, main characteristics and outcome of neuro-ophthalmological manifestations in BD. PATIENTS AND METHODS This is a retrospective monocentric study of 217 patients diagnosed with neuro-Behçet's disease (NBD), of whom 29 (13.3%) patients presented with neuro-ophthalmological manifestations (55% of men and mean±SD age of 26±8 years). All patients underwent a detailed ophthalmological examination and were followed up in the internal medicine and the ophthalmology departments. RESULTS Neuro-ophthalmological manifestations were the first presentation of BD in 45% of patients and developed later in the course of the disease in 55% of patients. They are divided into parenchymal (PM) and non-parenchymal (NPM)-related manifestations in, respectively, 13 patients (45%) and 16 patients (55%). PM included papillitis in seven patients (53.8%), retrobulbar optic neuritis in four patients (30.8%) and third cranial nerve palsy in two patients (15.4%). NPM included papilloedema related to cerebral venous thrombosis in all 16 patients, of whom 6 patients (37.5%) had sixth cranial nerve palsy. At initial examination, 93.1% of patients had visual alterations, including mainly decreased visual acuity visual field defects and/or diplopia. All patients were treated with corticosteroids and 79% of patients received immunosuppressive agents. After treatment, the visual outcome improved or stabilised in 66.7% of patients while it worsened in 33.3. The mean±SD logarithm of the minimum angle of resolution visual acuity improved from 0.4±0.3 at diagnosis to 0.2±0.3 after therapy. 10.3% and 3.4% of patients were legally blind at diagnosis and after therapy, respectively. CONCLUSION Neuro-ophthalmological manifestations of BD represented 13% of NBD. They could be potentially severe and disabling. Prompt treatment is the key factor in improving visual outcome.
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Affiliation(s)
- Ammr Alghamdi
- Ophthalmology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France.,Internal Medicine and Clinical Immunology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
| | - Chloé Comarmond
- Internal Medicine and Clinical Immunology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
| | - Anne Claire Desbois
- Internal Medicine and Clinical Immunology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
| | - Fanny Domont
- Internal Medicine and Clinical Immunology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
| | - Bertrand Wechsler
- Internal Medicine and Clinical Immunology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
| | - Raphael Depaz
- Neurology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
| | - Phuc Le Hoang
- Ophthalmology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
| | - Patrice Cacoub
- Internal Medicine and Clinical Immunology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
| | - Valérie Touitou
- Ophthalmology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
| | - David Saadoun
- Internal Medicine and Clinical Immunology Department, Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Pierre et Marie Curie University Paris VI, Paris, France
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16
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Yamada H, Saito K, Hokari M, Toru S. Brain biopsy to aid diagnosis of neuro-Behçet's disease: Case report and literature review. eNeurologicalSci 2017; 8:2-4. [PMID: 29260026 PMCID: PMC5730892 DOI: 10.1016/j.ensci.2017.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 11/24/2022] Open
Abstract
Central nervous system involvement in Behçet's disease (Neuro-Behçet's disease: NBD) has been reported to present diverse clinical and pathological manifestations. A few cases presenting with neurological symptoms preceding other systemic features are difficult to be diagnosed. Here we suggest the clinical benefit of brain biopsy with a case of NBD initially presenting neurological symptoms. We report one case of neuro-Behçet's disease (NBD). He presented with neurological symptoms without other preceding features. Brain biopsy was useful to diagnose him with NBD. Clinical utility of brain biopsy in NBD is suggested.
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Affiliation(s)
- Hiroki Yamada
- Department of Neurology, Nitobe Memorial Nakano General Hospital, Japan
| | - Kazuyuki Saito
- Department of Neurology, Nitobe Memorial Nakano General Hospital, Japan
| | - Mitsuhiko Hokari
- Department of Neurosurgery, Nitobe Memorial Nakano General Hospital, Japan
| | - Shuta Toru
- Department of Neurology, Nitobe Memorial Nakano General Hospital, Japan
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17
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Yılmaz ZV, Türkmen GG, Yılmaz E, Dağlar K, Kırbaş A, Sanhal C, Yücel A, Uygur D. Influence of Behçet's disease on first and second trimester serum screening markers. J Obstet Gynaecol Res 2016; 43:511-515. [DOI: 10.1111/jog.13237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/20/2016] [Accepted: 10/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Zehra Vural Yılmaz
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
| | | | - Elif Yılmaz
- Department of Obstetrics and Gynaecology; Dr. Sami Ulus Women's and Children's Health Training and Research Hospital; Ankara Turkey
| | - Korkut Dağlar
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
| | - Ayşe Kırbaş
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
| | - Cem Sanhal
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
| | - Aykan Yücel
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
| | - Dilek Uygur
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
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18
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Jade J, Chung K, Arendse M, Hussain Z, White D. Neuro-Behçet's disease presenting with tumour-like lesions and responding to rituximab. J Clin Neurosci 2016; 32:139-41. [PMID: 27320374 DOI: 10.1016/j.jocn.2016.03.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/14/2016] [Indexed: 11/29/2022]
Abstract
We describe a patient with neuro-Behçets disease (NBD) that presented with symptoms of raised intracranial pressure including papilloedema. MRI revealed tumour-like lesions which, on biopsy, confirmed an active vasculitis. Treatment was commenced with prednisone and cyclophosphamide which proved unsuccessful with enlargement of the cerebral mass lesions. Infliximab and mycophenolate were trialled also without benefit. The patient required ventriculoperitoneal shunts to relieve the symptoms of hydrocephalus. Rituximab was then commenced with significant symptomatic and imaging improvement. The case is unique, in our experience, in the need for shunting to relieve the symptoms of hydrocephalus related to vasculitis.
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Affiliation(s)
- J Jade
- Waikato DHB, Hamilton 3204, New Zealand
| | - K Chung
- Sydney Adventist Hospital Clinic, Wahroonga, NSW 2076, Australia
| | - M Arendse
- Waikato DHB, Hamilton 3204, New Zealand
| | - Z Hussain
- Waikato DHB, Hamilton 3204, New Zealand
| | - D White
- Waikato DHB, Hamilton 3204, New Zealand; Waikato Clinical School, Waikato Hospital, University of Auckland, Pembroke Street, Private Bag 3200, Hamilton 3240, New Zealand.
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19
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Abstract
OPINION STATEMENT Management of neuro-Behçet's disease can be divided into two stages: treatment of acute attacks and prevention of relapses. Treatment of acute attacks is accomplished by high-dose intravenous corticosteroids followed by maintenance treatment with oral steroids for 6-12 months depending on the type and severity of the neurological involvement. Relapses can be prevented by using immunosuppressants. Oral immunosuppressants such as azathioprine and mycophenolate are the most widely utilized agents for this purpose. Patients who are refractory or who cannot tolerate these medications can be managed by cyclophosphamide, interferon alpha, or anti-TNF-α monoclonal antibodies such as infliximab, etanercept, and adalimumab. Recent reports showed that newer agents such as tocilizumab, canakinumab, and anakinra, which exert their biological activity through IL-1 and IL-6 pathways, are also promising treatment alternatives for progressive or relapsing patients.
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Affiliation(s)
- Murat Kürtüncü
- Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Erdem Tüzün
- Institute of Experimental Medicine and Research, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Gulsen Akman-Demir
- School of Medicine, Department of Neurology, Istanbul Bilim (Science) University, Istanbul, Turkey.
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20
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Alonso S, Riveros-Frutos A, Martínez-Morillo M, Grau-Ferrer L, Carrato C, Olivé A. Pseudotumoral Behçet's disease. REUMATOLOGIA CLINICA 2016; 12:85-90. [PMID: 26078022 DOI: 10.1016/j.reuma.2015.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/03/2015] [Accepted: 03/13/2015] [Indexed: 06/04/2023]
Abstract
Behçet's disease is a systemic vasculitis characterized by the presence of oral and genital ulcers. Neurological involvement or neuro-Behçet is an uncommon manifestation. It manifestation has predominance in the male gender appearing 2 to 4 years after the first clinical manifestation. However, neuro-Behçet disease sometimes occurs with pseudotumoral brain lesions. Herein, we present the cases of two patients diagnosed with neuro-Behçet after detection of pseudotumoral brain lesions. A review of the literature is performed.
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Affiliation(s)
- Sara Alonso
- Sección de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España
| | - Anne Riveros-Frutos
- Servicio de Reumatología, Hospital Universitario Germans Trias i Pujol, Badalona, España.
| | | | - Laia Grau-Ferrer
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Badalona, España
| | - Cristina Carrato
- Servicio de Anatomía patológica, Hospital Universitario Germans Trias i Pujol, Badalona, España
| | - Alejandro Olivé
- Servicio de Reumatología, Hospital Universitario Germans Trias i Pujol, Badalona, España
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21
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Abstract
BD is a systemic inflammatory disease with a variable vasculitis. Paediatric onset is very rare and carries a strong genetic component. Oral ulcers and fever of unknown origin are frequent at onset and difficult to distinguish from other inflammatory disorders; therefore, expert opinion is still mandatory to recognize the disease early. An international expert consensus has recently proposed new classification criteria for children with BD. The clinical spectrum of BD is heterogeneous and influenced by gender, ethnicity and country of residence. Young males have the worst prognosis with significantly more frequent neurological, ocular and vascular involvement. BD treatment is aimed at alleviating inflammation. Among all drugs, TNFα inhibitors have become a standard to control severe ocular, neurological and digestive system involvement.
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Affiliation(s)
- Isabelle Koné-Paut
- Paediatric Rheumatology, CEREMAI, Bicêtre University Hospital, APHP, Paris SUD, Kremlin bicêtre, France.
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22
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Síndrome neurológico seudotumoral de la enfermedad de Behçet en un paciente tratado con antagonistas del factor de necrosis tumoral. Med Clin (Barc) 2015; 144:235-6. [DOI: 10.1016/j.medcli.2014.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/01/2014] [Accepted: 04/03/2014] [Indexed: 11/23/2022]
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23
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Leclercq D, Trunet S, Bertrand A, Galanaud D, Lehéricy S, Dormont D, Drier A. Cerebral tumor or pseudotumor? Diagn Interv Imaging 2014; 95:906-16. [PMID: 25260711 DOI: 10.1016/j.diii.2014.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pseudotumoral lesions are uncommon but important to identity lesions. They can occur during inflammatory diseases (systemic diseases, vasculitis, demyelinating diseases), infectious, and vascular diseases. Also, in a patient with a treated tumor, pseudo-progression and radionecrosis must be differentiated from the tumoral development. Diagnosis can be difficult on an MRI scan, but some MRI aspects in conventional sequences, diffusion, perfusion and spectroscopy can suggest the pseudotumoral origin of a lesion. Imaging must be interpreted according to the context, the clinic and the biology. The presence of associated intracranial lesions can orientate towards a systemic or infectious disease. A T2 hyposignal lesion suggests granulomatosis or histiocytosis, especially if a meningeal or hypothalamic-pituitary involvement is associated. Non-tumoral lesions are generally not hyperperfused. In the absence of a definitive diagnosis, the evolution of these lesions, whether under treatment or spontaneous, is fundamental.
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Affiliation(s)
- D Leclercq
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - S Trunet
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Bertrand
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Galanaud
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Lehéricy
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Dormont
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Drier
- Neuroradiology Department, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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24
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Noel N, Bernard R, Wechsler B, Resche-Rigon M, Depaz R, Le Thi Huong Boutin D, Piette JC, Drier A, Dormont D, Cacoub P, Saadoun D. Long-Term Outcome of Neuro-Behçet's Disease. Arthritis Rheumatol 2014; 66:1306-14. [DOI: 10.1002/art.38351] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 01/02/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Nicolas Noel
- APHP Groupe Hospitalier Pitié Salpétrière, and DHU Inflammation, Immunopathologie, Biothérapie, Université Pierre et Marie Curie, Paris VI; Paris France
| | | | - Bertrand Wechsler
- APHP Groupe Hospitalier Pitié Salpétrière, and DHU Inflammation, Immunopathologie, Biothérapie, Université Pierre et Marie Curie, Paris VI; Paris France
| | | | - Raphaël Depaz
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | - Du Le Thi Huong Boutin
- APHP Groupe Hospitalier Pitié Salpétrière, and DHU Inflammation, Immunopathologie, Biothérapie, Université Pierre et Marie Curie, Paris VI; Paris France
| | - Jean-Charles Piette
- APHP Groupe Hospitalier Pitié Salpétrière, and DHU Inflammation, Immunopathologie, Biothérapie, Université Pierre et Marie Curie, Paris VI; Paris France
| | - Aurélie Drier
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | - Didier Dormont
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | - Patrice Cacoub
- APHP Groupe Hospitalier Pitié Salpétrière, and DHU Inflammation, Immunopathologie, Biothérapie, Université Pierre et Marie Curie, Paris VI; Paris France
| | - David Saadoun
- APHP Groupe Hospitalier Pitié Salpétrière, and DHU Inflammation, Immunopathologie, Biothérapie, Université Pierre et Marie Curie, Paris VI; Paris France
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25
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Abstract
Behçet syndrome (BS) is an idiopathic chronic relapsing multisystem vascular-inflammatory disease of unknown origin. As the disease affects many organs and systems and shows a wide range of clinical manifestations and presentations, it is prefereable to call Behçet's a syndrome (BS) rather than a disease. Nervous system involvement, known as "neuro-BS" (NBS), is seen in about 5-10% of all cases. Clinical and imaging evidence suggests that primary neurologic involvement in BS may be subclassified into two major forms: the first, which is seen in the majority of patients, may be characterized as a vascular-inflammatory central nervous system disease with focal or multifocal parenchymal involvement, mostly presenting with a subacute brainstem syndrome and hemiparesis (intra-axial NBS); the other, which has few symptoms and a better neurologic prognosis, may be caused by isolated cerebral venous sinus thrombosis and intracranial hypertension (extra-axial NBS), occurring in 10-20% of the cases. These two types are rarely seen in the same individual, and their pathogenesis is likely to be different. Isolated behavioral syndromes and peripheral nervous system involvement are rare, whereas a vascular type headache is relatively common and independent from neurologic involvement. Neurologic complications secondary to systemic involvement of BS, as well as neurologic complications related to BS treatments are considered as secondary neurologic involvement of the syndrome. The core histopathologic phenomenon seems to be a vasculitic involvement in some cases, and low-grade chronic nonspecific inflammation in others. As the neurologic involvement in this syndrome is so heterogeneous, it is difficult to predict its course and prognosis, and its response to treatment. Currently, treatment options for NBS are limited to attack therapies with high-dose intravenous methylprednisolone followed by a prolonged oral taper, symptomatic management, and generally the use of azathioprine, cyclophosphamide, interferon-α and anti-TNF agents for long-term preventive treatment, although there no evidence for their efficacy.
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Affiliation(s)
- Sabahattin Saip
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Gulsen Akman-Demir
- Department of Neurology, School of Medicine, Istanbul Bilim University, Istanbul, Turkey
| | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
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26
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Mochol M, Berg K, Midtvedt Ø, Ringstad G, Kerty E. Kvinne med residiverende uveitter og nevrologiske utfall. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:1245-8. [DOI: 10.4045/tidsskr.13.0433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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27
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Noel N, Drier A, Wechsler B, Piette JC, De Paz R, Dormont D, Cacoub P, Saadoun D. [Neurological manifestations of Behçet's disease]. Rev Med Interne 2013; 35:112-20. [PMID: 24290030 DOI: 10.1016/j.revmed.2013.10.332] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/12/2013] [Indexed: 11/17/2022]
Abstract
Neurological manifestations of Behçet's disease (BD) occur in 5.3 to more than 50% of patients. They are divided into two major forms: "parenchymal" lesions, which include mainly meningoencephalitis as opposed to "extra-parenchymal" lesions (i.e. cerebral venous thrombosis and arterial aneurysms). Myelitis or peripheral neuropathy is exceptional. The neuro-Behçet syndrome (NBS) should be considered in the setting of neurological manifestations, particularly headache and pyramidal signs, in a young man diagnosed with BD. However, its recognition may be difficult when neurological manifestations are the presenting features of BD (one third of cases), and requires a thorough knowledge of clinical manifestations and morphological lesions. Thus, parenchymal NB lesions classically exhibit inflammatory characteristics on MRI and are located at the meso-diencephalic junction and in the brainstem, rarely with a supratentorial extension. Meningitis is not systematically associated, and may be absent in about 30% of cases. The pathogenesis of these lesions is incompletely understood, but inflammatory infiltrates include mainly neutrophils and activated T cells (mainly Th17). Differential diagnoses include infectious diseases (herpes, listeria, tuberculosis), and inflammatory diseases (i.e. multiple sclerosis and sarcoidosis). A prompt recognition of NBS should lead to initiate adequate therapies in order to limit the risk of sequelae, relapses or death.
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Affiliation(s)
- N Noel
- Service de médecine interne 2, centre de référence des maladies autoimmunes rares, DHU i2B, immunopathologie, inflammation, biothérapie, université Pierre-et-Marie-Curie, Paris 6, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - A Drier
- Service de neuroradiologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - B Wechsler
- Service de médecine interne 2, centre de référence des maladies autoimmunes rares, DHU i2B, immunopathologie, inflammation, biothérapie, université Pierre-et-Marie-Curie, Paris 6, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - J-C Piette
- Service de médecine interne 2, centre de référence des maladies autoimmunes rares, DHU i2B, immunopathologie, inflammation, biothérapie, université Pierre-et-Marie-Curie, Paris 6, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, 75013 Paris, France
| | - R De Paz
- Service de neurologie, groupe hospitalier Pitié-Salpétrière, AP-HP, 75013 Paris, France
| | - D Dormont
- Service de neuroradiologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, 75013 Paris, France
| | - P Cacoub
- Service de médecine interne 2, centre de référence des maladies autoimmunes rares, DHU i2B, immunopathologie, inflammation, biothérapie, université Pierre-et-Marie-Curie, Paris 6, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, 75013 Paris, France
| | - D Saadoun
- Service de médecine interne 2, centre de référence des maladies autoimmunes rares, DHU i2B, immunopathologie, inflammation, biothérapie, université Pierre-et-Marie-Curie, Paris 6, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Faculté de médecine, université Pierre-et-Marie-Curie, Paris 6, 75013 Paris, France.
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28
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Noel N, Wechsler B, Nizard J, Costedoat-Chalumeau N, Boutin DLTH, Dommergues M, Vauthier-Brouzes D, Cacoub P, Saadoun D. Behçet's Disease and Pregnancy. ACTA ACUST UNITED AC 2013; 65:2450-6. [DOI: 10.1002/art.38052] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/04/2013] [Indexed: 01/28/2023]
Affiliation(s)
- Nicolas Noel
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - Bertrand Wechsler
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - Jacky Nizard
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | | | - Du Le Thi Huong Boutin
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - Marc Dommergues
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - Danièle Vauthier-Brouzes
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - Patrice Cacoub
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
| | - David Saadoun
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Université Pierre et Marie Curie, Paris VI; Paris France
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29
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Pipitone N, Versari A, Hunder GG, Salvarani C. Role of imaging in the diagnosis of large and medium-sized vessel vasculitis. Rheum Dis Clin North Am 2013; 39:593-608. [PMID: 23719077 DOI: 10.1016/j.rdc.2013.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In large-vessel vasculitis, imaging studies are useful to document temporal artery involvement and crucial to show large-vessel involvement. Color Doppler sonography, magnetic resonance, and computed tomography show early vasculitic lesions. Angiography delineates later vascular complications well. Color Doppler sonography, magnetic resonance angiography, and computed tomography angiography can also be used to show vascular luminal changes. Positron emission tomography is very sensitive in detecting large-vessel inflammation. Imaging procedures can also be used to monitor the course of large-vessel vasculitis. In medium-vessel vasculitis, imaging studies can be used to show both vascular changes and internal organ changes.
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Affiliation(s)
- Nicolò Pipitone
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia 42123, Italy
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