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Castellazzi M, Candeloro R, Pugliatti M, Govoni M, Silvagni E, Bortoluzzi A. Cerebrospinal Fluid Analysis in Rheumatological Diseases with Neuropsychiatric Complications and Manifestations: A Narrative Review. Diagnostics (Basel) 2024; 14:242. [PMID: 38337758 PMCID: PMC10854855 DOI: 10.3390/diagnostics14030242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
The analysis of cerebrospinal fluid (CSF) remains a valuable diagnostic tool in the evaluation of inflammatory and infectious conditions involving the brain, spinal cord, and meninges. Since many rheumatic inflammatory diseases can involve the central and peripheral nervous system, the aims of this narrative review were to summarize the latest evidence on the use of CSF analysis in the field of neuropsychiatric manifestations of rheumatic diseases. Routine CSF parameters were taken into consideration for this review: appearance; total protein and cellular content (pleocytosis); lactate and/or glucose; CSF/serum albumin quotient; intrathecal synthesis of IgG. Data regarding the role of CSF analysis in the clinical management of neuropsychiatric systemic lupus erythematosus, primary Sjogren's syndrome, rheumatoid arthritis, and Behçet's syndrome are presented. Although no disease-specific picture has been identified, CSF analysis remains a useful diagnostic tool to confirm the presence of a neuro-inflammatory state or, conversely, to exclude the concomitant presence of other inflammatory/infectious diseases affecting the CNS in the context of systemic rheumatologic conditions.
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Affiliation(s)
- Massimiliano Castellazzi
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Raffaella Candeloro
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Maura Pugliatti
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Marcello Govoni
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
| | - Ettore Silvagni
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
| | - Alessandra Bortoluzzi
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
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Sönmez HE, Batu ED. DIFFERENCES IN BEHÇET’S DISEASE PHENOTYPE ACCORDING TO SEX: HYPOTHESES AND RESEARCH PERSPECTIVES. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2022. [DOI: 10.47316/cajmhe.2022.3.3.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Behçet's disease (BD) is a multisystem vasculitis affecting both arteries and veins. Although the disease affects both sexes equally, males and females may express different phenotypes. The exact association between sex-related factors and BD phenotype is not clear, while many factors, such as genetic factors, hormones, and environmental and epigenetic factors may be the underlying factors of sex-related differences. This article summarizes the current literature focusing on the underlying factors determining differences in BD phenotype according to sex.
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Hamid M, Adan K, Satte A, Bourazza A. Chorea in Neuro-Behçet's Disease. Cureus 2021; 13:e19039. [PMID: 34853756 PMCID: PMC8608035 DOI: 10.7759/cureus.19039] [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] [Accepted: 10/24/2021] [Indexed: 12/05/2022] Open
Abstract
Behçet’s disease (BD) was described as a multisystemic recurrent inflammatory disorder of unknown cause comprising uveitis, skin lesions, recurrent genital, and oral ulcers. Involvement of the central nervous system in BD is about 10-25%. Chorea is defined as a hyperkinetic movement disorder, which can be caused by different etiologies. It was rarely mentioned in the literature as a manifestation of neuro-Behçet’s disease (NB). Radiological lesions are predominant in basal ganglia and periventricular white matter. The evolution of chorea in NB is variable in literature studies. We present a rare case of parenchymal NB with chorea.
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Affiliation(s)
- Mohamed Hamid
- Department of Neurology, Mohamed V Military Teaching Hospital, Mohamed V University, Rabat, MAR
| | - Kadira Adan
- Department of Neurology, Mohamed V Military Teaching Hospital, Mohamed V University, Rabat, MAR
| | - Amal Satte
- Department of Neurophysiology, Mohamed V Military Teaching Hospital, Mohamed V University, Rabat, MAR
| | - Ahmed Bourazza
- Department of Neurology, Mohamed V Military Teaching Hospital, Mohamed V University, Rabat, MAR
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Tramontini PL, Finkelsztejn A, Duarte JÁ, Santos GT, Roesler R, Isolan GR. Neuro-Behçet disease mimicking brain tumor: A case report. Surg Neurol Int 2017; 8:97. [PMID: 28695044 PMCID: PMC5473079 DOI: 10.4103/sni.sni_3_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/31/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Behçet's disease (BD) is an inflammatory multisystem disease with unknown etiology, and consists of a TRIAD comprising recurrent oral ulcers, genital ulcers, and uveitis. In some cases, the disease affects the central nervous system, called Neuro-Behçet Disease (NBD). Few cases of NBD simulating a brain tumor have been previously reported. CASE DESCRIPTION Here, we describe the case of a 46-year-old male patient with a previous diagnosis of brain tumor who was later diagnosed for BD. CONCLUSION This case highlights the importance of differential diagnosis of lesions with tumoral features. Checking for the possibility of NBD may help avoiding biopsy in these types of cases.
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Affiliation(s)
- Pedro L Tramontini
- Neurosurgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Juliana Á Duarte
- Radiology Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Guilherme T Santos
- Neurosurgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Rafael Roesler
- Department of Pharmacology, Institute for Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Cancer and Neurobiology Laboratory, Experimental Research Center, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Brazil
| | - Gustavo R Isolan
- Neurosurgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Advanced Center of Neurology and Neurosurgery (CEANNE)-Brazil, Porto Alegre, RS, Brazil
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Gender Differences in Behçet's Disease Associated Uveitis. J Ophthalmol 2014; 2014:820710. [PMID: 24864195 PMCID: PMC4017716 DOI: 10.1155/2014/820710] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 12/14/2022] Open
Abstract
Behçet's disease is a systemic vasculitis of unknown etiology, characterized by oral and genital ulceration, skin lesions, and uveitis as well as vascular, central nervous system, and gastrointestinal system involvement. It is prevalent in the Middle East, Mediterranean, and Eastern Asia. The aim of this review is to evaluate the gender differences in clinical manifestations of Behçet's disease, treatment responses, mortality, and morbidity. Behçet's disease has been reported to be more prevalent in males from certain geographic regions and particular ethnic groups; however, recent reports indicate more even gender distribution across the world. There are gender differences in clinical manifestations and severity of the disease. Ocular manifestations, vascular involvement, and neurologic symptoms are more frequently reported in male patients whereas oral and genital ulcers, skin lesions, and arthritis occur more frequently in female patients. The disease can have a more severe course in males, and overall mortality rate is significantly higher among young male patients.
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Onyx Embolization of Ruptured Intracranial Aneurysm Associated with Behçet's Disease. Case Rep Vasc Med 2013; 2013:797045. [PMID: 24224110 PMCID: PMC3800601 DOI: 10.1155/2013/797045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/07/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction. Intracranial aneurysms associated with Behçet's disease (BD) are a rare occurrence. They are fragile, thin-walled pseudoaneurysms, which have high tendency to rupture and present a therapeutic challenge. Case Presentation. We report a 26-year-old male with BD presented with subarachnoid hemorrhage due to ruptured middle cerebral artery aneurysm. Additionally, two unruptured aneurysms were identified. He underwent endovascular embolization using Onyx with successful obliteration of the ruptured aneurysm. Medical therapy resulted in regression of one and resolution of the other aneurysms. Conclusion. We describe the first report of the application of Onyx for obliteration of ruptured cerebral aneurysm in BD as a feasible and safe therapeutic option for patients who are not candidates for other techniques.
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Cerebral Aneurysms: A Rare Feature of Behçet's Disease—A Case Report and Review of the Literature. Case Rep Neurol Med 2013; 2013:812158. [PMID: 23984129 PMCID: PMC3747382 DOI: 10.1155/2013/812158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 07/10/2013] [Indexed: 11/30/2022] Open
Abstract
Behçet's disease (BD) is a multisystem vascular inflammatory disease with several clinical manifestations. Intracranial aneurysms are an extremely rare but nevertheless severe complication of BD. We report a case of a 44-year-old man. The diagnosis of BD was made based on the presence of recurrent oral aphthous ulcers and positive human leukocyte antigen (HLA-) B51 in the absence of evidence of other diseases. MRI showed an ancient ischemic right capsulolenticular lesion, subacute white matter hypersignals of the left capsule lenticular region, and multiple arterial aneurysms. The patient underwent two-month systemic high-dose corticosteroids and immunosuppressive therapy associated with severe neurological deficiency upon admission and severe impairment upon discharge. A thorough review of the literature showed 20 case reports of intracranial aneurysms in BD.
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Ozveren MF, Matsumoto Y, Kondo R, Takahashi A. Coil embolization of an unruptured intracranial aneurysm associated with Behcet's disease: case report. Neurol Med Chir (Tokyo) 2010; 49:471-3. [PMID: 19855145 DOI: 10.2176/nmc.49.471] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 36-year-old male patient with Behcet's disease consulted our hospital for treatment of an unruptured intracranial aneurysm. He was neurologically intact. He had undergone surgery for an aneurysm of the superior mesenteric artery 2 years ago and had been followed up because of the aneurysm of the left radial artery for 1 year. He had been receiving steroid treatment for 4 years. Three-dimensional computed tomography angiography identified an aneurysm of the left intracranial internal carotid artery. The lesion was treated by coil embolization. He was discharged without complications. Intracranial aneurysm formation is extremely rare in patients with Behcet's disease. The presence of extracranial aneurysms indicates screening for intracranial aneurysms. The present case shows that coil embolization can be used to treat unruptured intracranial aneurysm in patients with Behcet's disease.
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Affiliation(s)
- Mehmet Faik Ozveren
- Department of Neurosurgery, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
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9
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Cerebrovascular manifestations of Behçet’s disease. J Clin Neurosci 2009; 16:576-8. [DOI: 10.1016/j.jocn.2008.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 01/21/2008] [Accepted: 05/06/2008] [Indexed: 11/18/2022]
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10
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Heo JH, Lee ST, Chu K, Kim M. Neuro-Behcet's disease mimicking multiple brain tumors: Diffusion-weighted MR study and literature review. J Neurol Sci 2008; 264:177-81. [PMID: 17850821 DOI: 10.1016/j.jns.2007.07.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 07/16/2007] [Accepted: 07/25/2007] [Indexed: 11/29/2022]
Abstract
A 47-year-old man with Behcet's disease presented with a five day history of right side weakness and dysarthria. Ten years ago, he was diagnosed as Behcet's disease. Since then, he was treated with low dose steroids. T1-weighted magnetic resonance images with gadolinium injection revealed ring enhancing lesions with internal hypointensities at the left side of the pons and at the left parietal cortex suggesting multiple metastatic tumors. Diffusion-weighted image and ADC map revealed central hyperintensity on diffusion with low ADC values at both lesions. The histopathology of stereotactic biopsy specimen showed frequent perivascular lymphocytic cuffings, focal necrotic lesions and reactive gliosis. The most common neuropathologic findings in neuro-Behcet's disease are focal necrotic lesions, but the location in cerebral cortex has not been reported before. Long term steroid therapy and antibiotics were administered and the patient recovered gradually. Neuro-Behcet's disease could be presented as brain tumor like lesion, and stereotactic biopsy should be considered in such situation.
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Affiliation(s)
- Jae-Hyeok Heo
- Department of Neurology, Seoul National University Hospital, 28 Yeongeon-dong, Jongno-gu, Seoul, 110-744, South Korea
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Kaku Y, Hamada JI, Kuroda JI, Kai Y, Morioka M, Kuratsu JI. Multiple peripheral middle cerebral artery aneurysms associated with Behcet's disease. Acta Neurochir (Wien) 2007; 149:823-7; discussion 827. [PMID: 17585365 DOI: 10.1007/s00701-007-1226-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 05/09/2007] [Indexed: 11/25/2022]
Abstract
We report a 19-year-old woman with Behcet's disease who suffered a subarachnoid hemorrhage and had bilateral peripheral middle cerebral artery aneurysms. After steroid therapy for 3 days, the smaller aneurysm disappeared. The larger aneurysm was excised and the artery reconstructed using a superficial temporary artery graft. Histological examination showed vasculitis restricted to the wall of the aneurysm. This is the first report of arterial reconstruction for an aneurysm associated with Behcet's disease. Steroid therapy before the operation may facilitate repair of the arterial wall.
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Affiliation(s)
- Y Kaku
- Department of Neurosurgery, School of Medicine, Kumamoto University, Kumamoto, Japan
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Gökçay F, Çelebisoy N, Oran İ, Aksu K. Behçet's Disease-Associated Aneurysm of the Internal Carotid Artery within the Cavernous Sinus: Report of a Patient. Neuroophthalmology 2007. [DOI: 10.1080/01658100601166243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ho CL, Deruytter MJ. Manifestations of Neuro-Behçet’s disease. Clin Neurol Neurosurg 2005; 107:310-4. [PMID: 15885390 DOI: 10.1016/j.clineuro.2004.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2004] [Revised: 06/18/2004] [Accepted: 07/04/2004] [Indexed: 11/28/2022]
Abstract
Behcet's disease (BD) is a rare condition, more commonly seen in Turkey, the Middle East, the Mediterranean, and the Far Eastern countries. It is a multifaced disease involving the central nervous system (CNS), skin, joints, intestines and blood vessels. CNS involvement occurs in 10-25% of the patients with BD. We report two cases with Neuro-Behcet's disease. Both patients were females and they were in their second decade of life (early forties) when they suffered from relapsing retinitis and uveitis which led to blindness, despite treatment with steroids. They presented with clinical signs of brainstem syndrome, meningoencephalitis and the initial radiological investigations of our patients revealed encephalitic lesions in the brainstem. In the first case, an intracerebral abscess developed 4 years later, and it was evacuated under stereotactic guidance. The most common neuropathologic findings in Neuro-Behcet's disease are focal necrotic lesions in the brain. However, the association of Behcet's disease (BD) with cerebral abscess is very rare. There were only three reported cases of such. Ten years after the initial diagnosis of BD, our second patient suffered from subarachnoid hemorrhage due to a ruptured aneurysm of the superior cerebellar artery, which was then resected successfully. Intracranial aneurysm in patients with Behcet's disease has previously been documented in eight patients. To our knowledge, this is the only case of Neuro-Behcet's disease associated with an aneurysm of the superior cerebellar artery.
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Affiliation(s)
- Chi Long Ho
- Department of Neurosurgery, Heilig Hart (Teaching Hospital) Hospital, Wilgenstraat 2, Roeselaere 8800, Belgium.
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Abstract
BACKGROUND Behçet disease is a vasculitis with mucocutaneous, ocular, arthritic, vascular, and other manifestations. Its neurologic manifestations (neuro-Behçet disease) are relatively rare, but they must be thoroughly investigated due to their grave prognosis. REVIEW SUMMARY The frequency of neurologic manifestations, more common in male Behçet patients, is between 5% and 30%. Both the central and peripheral nervous systems can be involved. Central nervous system manifestations can be divided into 2 main groups: (1) parenchymal involvement, which includes brainstem involvement, hemispheric manifestations, spinal cord lesions, and meningoencephalitic presentations; (2) nonparenchymal involvement, including dural sinus thrombosis, arterial occlusion, and/or aneurysms. Peripheral neuropathy and myopathy are relatively rare. Cerebrospinal fluid analysis reveals pleocytosis and elevated protein levels. Magnetic resonance imaging is the investigation of choice which often reveals iso-/hypointense lesions in T1-weighted images and hyperintense lesions in T2-weighted images, mostly in the mesodiencephalic junction, cerebellar peduncles, and other parts of the brainstem. Corticosteroids and adjuvant immunosuppressive therapy are used for parenchymal manifestations, and corticosteroids and anticoagulants are used for treatment of dural sinus thrombosis. CONCLUSION Neuro-Behçet disease must be considered in the differential diagnosis of stroke in young adults, multiple sclerosis, movement disorders, intracranial hypertension, intracranial sinovenous occlusive diseases, and other neurologic syndromes.
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Koçak A, Cayli SR, Ateş O, Saraç K. Middle Cerebral Artery Aneurysm Associated With Behcet's Disease-Case Report-. Neurol Med Chir (Tokyo) 2004; 44:368-71. [PMID: 15347214 DOI: 10.2176/nmc.44.368] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 37-year-old man with Behçet's disease suffered secondary subarachnoid hemorrhage and intracerebral hematoma in the right temporal lobe caused by a ruptured aneurysm of the right middle cerebral artery. The aneurysm was successfully clipped. Aneurysm formation is common in the visceral arteries in Behçet's disease, but extremely rare in the intracranial arteries. Vasculitis may be involved in the etiology of intracranial aneurysms in patients with Behçet's disease.
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Affiliation(s)
- Ayhan Koçak
- Department of Neurosurgery, Inönü University Faculty of Medicine, Malatya, Turkey.
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Kizilkilic O, Albayram S, Adaletli I, Ak H, Islak C, Kocer N. Endovascular treatment of Behçet's disease-associated intracranial aneurysms: report of two cases and review of the literature. Neuroradiology 2003; 45:328-34. [PMID: 12690419 DOI: 10.1007/s00234-003-0952-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2002] [Accepted: 01/13/2003] [Indexed: 11/29/2022]
Abstract
Behçet's disease (BD) is a well-known multisystem inflammatory disorder of unknown etiology. Aneurysms of the cerebral arteries are not commonly described in patients with BD. There are few cases of intracranial aneurysms with BD reported in the literature. In this study, we report endovascular treatment of BD-related ruptured intracranial aneurysms in two cases, and present a wide literature review of intracranial arterial aneurysms related to BD.
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Affiliation(s)
- Osman Kizilkilic
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical School, 34300, Kocamustafapasa, Istanbul, Turkey
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Rosenstingl S, Dupuy E, Alves O, George B, Tobelem G. [Behcet's disease manifested as a intracranial aneurysm]. Rev Med Interne 2001; 22:177-82. [PMID: 11234676 DOI: 10.1016/s0248-8663(00)00308-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Mostly venous (95% of all vascular complications), and less frequently arterial (2 to 7% of all cases), vascular complications are commonplace in Behçet's disease (23 to 64% of the patients, depending on the series). Arterial complications are stenosis, occlusions and especially severe due to their unpredictable rupture risk, aneurysms. Intracranial aneurysms associated with Behçet's disease are exceptional. Until now, only ten cases have been published. EXEGESIS We report the case of a 36-year-old patient of Armenian origin in whom the diagnosis of Behçet's disease was made after a subarachnoid hemorrhage caused by the rupture of a left superior cerebellar artery aneurysm. The endovascular treatment of the aneurysm was associated with an immunosuppressive treatment consisting of cyclophosphamide, corticoids and colchicine. Within a 6-month period of follow up the evolution has been favorable. This is the first published case report of Behçet's disease associated with an aneurysm of the posterior circulation treated endovascularly. A review of the literature is also included. CONCLUSION Intracranial aneurysms are an exceptional but nevertheless severe localization of vascular complications in Behçet's disease. As in all other arterial lesions, recurrences are frequent. The treatment involves surgical or endovascular treatment that should be associated with corticoids and immunosuppressive therapy. Colchicine is useful for the prevention of relapses.
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Affiliation(s)
- S Rosenstingl
- Service d'angiohématologie clinique, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
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