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Neuro-Behçet disease

Case contributed by Dr Mahmoud Yacout Alabd

Presentation

Known patient with Behçet disease, currently suffering from headache and upper limbs paresthesia.

Patient Data

Age: 60 years
Gender: Male

MRI Brain

MRI

Scattered T2 and FLAIR bright white matter lesions seen at the periventricular and subcortical regions, the basal ganglia as well as the brain stem, mainly the midbrain and pons. There is involvement of the corticospinal tracts, more at the right side, best seen at the coronal T2 scan where we see linear bright signal involving the right corticospinal tract at the pons and up to the mid brain and external capsule with corresponding atrophy of right peduncle of the mesencephalon and right side of the pons (seen at the axial T2 and FLAIR).

The lesions show no mass effect, no related edema, no diffusion restriction or appreciable post contrast enhancement, denoting no disease activity. 

Case Discussion

Scattered white matter lesions seen at the periventricular and subcortical regions bilaterally, the basal ganglia, the brain stem, mainly the midbrain and pons, involving the corticospinal tracts, with atrophy of the right peduncle of the mesencephalon and right side of the pons. These features are in keeping with Neuro-Behçet disease, especially the targeting of the corticospinal tracts and brain stem that helps to differentiate Neuro-Behçet disease from non-specific white matter microvascular ischemic changes. No MRI evidence of active disease as there is no post contrast enhancement of the lesions, no mass effect or edema and no diffusion restriction. 

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