Bir, Levent Sinan

Erdoǧan, Berna Şanlı

Kılınçer, Ahmet

Sabir, Nuran

Çeliker, Arif

English

Pamukkale Üniversitesi Açık Erişim Arşivi

Aseptic meningitis, 
venous sinus thrombosis,
intracranial hypertension
and callosal involvement
contemporaneously 
in a young patient with 
Behçet’s disease
Levent Sinan Bira, Nuran Sabirb, 
Ahmet Kılınçera, Arif Çelikera, 
Berna Şanlı Erdoǧanc
a Pamukkale University Medical Faculty, 
Departments of Neurology,
b Radiology,
c Dermatology, Denizli, Turkey
Behçet’s disease is a multisystemic in-
flammatory disorder [1]. Parenchymal (65–
81%) and vascular (19–27.5%) forms were
defined for neurological involvement [1, 2].
Sinus thrombosis and intracranial hyperten-
sion are the most common examples of the
vascular form [1]. It is very uncommon that
these two forms of the disease occur in the
same individual [1]. In this report we present
a case with neuro-Behçet’s disease (n-BD)
that had signs of both clinical forms contem-
poraneously including aseptic meningitis,
venous sinus thrombosis, intracranial hyper-
tension and a callosal lesion.
A 27-year-old male patient presented
with headache, papilloedema and neck stiff-
ness. In cranial MRI, superior sagittal sinus
thrombosis, prominent meningeal contrast
enhancement (figure 1) and a lesion of 1 cm
in diameter located in the splenium of the cor-
pus callosum enhancing with gadolinium on
T1W and hyperintense on T2W (figure 2a)
were seen. CSF pressure was measured as 
600 cmH2O; a high lymphocyte count and an
increased level of protein were detected. A ten
year history of recurrent oral aphthus, genital
ulcerations and positive pathergy test directed
to Behçet’s disease. Methylprednisolone, aza-
thioprine, acetazolamide were used. Symp-
toms and signs resolved completely in one
year. Follow up MRI revealed complete re-
canalisation of the thrombosis and disappear-
ance of the callosal lesion (figure 2b).
This case shows that major clinical forms
can be seen in the same patient synchronically
in n-BD. Isolated hyperintense white matter
lesion located in the splenium of the corpus
callosum is another interesting point of the
case. In the literature only one n-BD case with
similar callosal involvement was found [3].
We saw reversible callosal lesions in multiple
sclerosis and its variants and but in this patient
a detailed history and CSF immunological
analysis were not consistent with neither of
them. 
Correspondence:
Dr. Levent Sinan Bir
Pamukkale Universitesi Tıp Fakültesi
Hastanesi
Nöroloji Anabilim Dalı Kat 1 
B105Kınıklı
20070 Denizli Turkey
E-Mail: sbir@pamukkale.edu.tr
References
1 Akman-Demir G, Serdaroǧlu P, Tasçı B and the
Neurobehçet Study Group. Clinical patterns of
neurological involvement in Behçet’s disease: eval-
uation of 200 patients. Brain 1999;122:2171–81.
2 Al-Fahad SA, Al-Araji AH. Neuro-Behçet’s disease
in Iraq: a study of 40 patients. J Neurol Sci 1999;
170:105–11.
3 Lackmann GM, Lyding S, Scherer A, Niehues T.
Acute Disseminated Encephalomyelitis and Mu-
cocutaneous Ulcerations. Neuropediatrics 2004;
35:253–4.
S W I S S  M E D  W K LY 2 0 0 5 ; 1 3 5 : 6 8 4 ·  w w w. s m w. c h
Peer reviewed article
684Original articleLetter to the editor
Figure 1
T1 SE post-contrast image shows the contrast
enhancement of meninges and saggital sinus
thrombosis.
Figure 2
a. Callosal lesion in T2 SE axial image.
b. Follow-up MRI shows disappearance of the lesion.
a b
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Aseptic meningitis, venous sinus thrombosis, intracranial hypertension and callosal involvement contemporaneously in a young patient with Behçet's disease

http://acikerisim.pau.edu.tr:8080/xmlui/bitstream/11499/4759/1/smw_2005_11228.pdf

Aseptic meningitis, venous sinus thrombosis, intracranial hypertension and callosal involvement contemporaneously in a young patient with Behçet's disease

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Pamukkale Üniversitesi Açık Erişim Arşivi