MRI features of neuro-Behcet disease

A 52-year-old man of central African origin was admitted to our emergency department for left hemiparesia and vertigo. He has presented unusual right hemicranial headaches for 4 days. One month prior to admission, he suffered from unexplained abdominal pain with diarrhea, lower back pain and hyperthermia. Past medical history revealed episodes of unexplained abdominal pain, arthralgia, aphthous stomatitis, hyperthermia, and retinal periphlebitis. MRI (Fig. A) and MS-CT (Fig. B) studies with contrast material injection were performed and revealed two focal cerebral lesions: one, binodular, on the anterior crus of the right internal capsule, with extension to the lentiform nucleus and the head of the caudate nucleus; the second was centred on the right thalamus and the posterior crus of the right internal capsule. These two lesions presented an important enhancement after contrast material injection, a broad peripheral vasogenic oedema on FLAIR sequences (Fig. C), a moderate mass effect on the right lateral ventricle, and were evocative of non-necrosing inflammatory encephalitis lesions. Cerebrospinal fluid (CSF) analyses showed elevated lymphocytosis and high protein level. Several IgG oligoclonal bands were detected, and confirmed a CNS inflammatory injury. A surgical cerebral biopsy and anatomo-pathologic examination revealed a typical image of vasculitis with neutrophilic and eosinophilic invasion of the perivascular spaces. These results, associated with clinical symptoms, confirmed the diagnosis of Neuro-Behcet. He benefited from Solumedrol and Imuran treatment.