Cranial Magnetic Resonance Imaging Findings in Patients with Neuro-Behcet's Syndrome

OBJECTIVE: Behcet’s disease is a multisystemic, vascular-inflammatory disease of unknown origin. Impairment of the central nervous system is rare, and young adults can present with brain stem syndrome or hemiparesis. In this study, we aimed to determine the cranial magnetic resonance imaging (MRI) patterns in patients diagnosed as parenchymal or nonparenchymal neuro-Behcet’s syndrome who did not have headache. METHODS: Thirty-eight patients admitted to the Haydarpasa Numune Training and Research Hospital, Department of 1st Neurology and GATA Haydarpasa Training Hospital Neurology Department, Istanbul between 2003 and 2009 in the acute period and with the diagnosis of neuro-Behcet’s syndrome were investigated. All the patients were examined by routine hematological and biochemical blood tests, vasculitis tests, cranial MRI, and magnetic resonance venography if needed. Patients with headache and those without cranial MRI lesions were excluded. RESULTS: Eighteen patients, with a mean age of 34.6 ± 9.7 and age range of 17-51, were investigated. Eleven of the patients were male and seven were female. In 14 patients, the diagnosis of Behcet’s disease was present for 11.5 years, while four patients were newly diagnosed after admission. The most common complaints were hemiparesis, dysarthria and diplopia due to the cranial nerve involvement. Twelve of the patients were admitted with the first attack, five with the second attack and one with the third attack in the acute period. Sixteen patients with parenchymal neuro-Behcet’s syndrome had a total of 41 lesions, and the brain stem was the most common localization (55.6%). Of the two patients with nonparenchymal neuro-Behcet’s syndrome, thrombosis was observed in the superior sagittal sinus in one and in the transverse sinus in the other. CONCLUSION: Cranial MRI is a sensitive diagnostic technique for neuro-Behcet’s syndrome. MRI is a noninvasive diagnostic tool to confirm the involvement of the central nervous system and has an important role in confirming the stage of the illness in Behcet’s disease