|Vol. 4, Issue 2, Article 1||Saleem, S.|
Behcet's disease (BD) is a multi-system disorder of unknown etiology. it frequently involves the nervous system, in which case it is referred to as Neuro-Behcet’s disease (NBD). The purpose of this article is to recognize the MRI findings in NBD and to differentiate between it and other disorders, such as systemic lupus erythematosus (SLE) and multiple sclerosis (MS). The neurological manifestations in BD are classified into two groups: the primary neural parenchymal group and secondary non-parenchymal group.
The parenchymal lesions in NBD have a distinct distribution involving the meso-diencephalic junction and extend along certain fiber tracts. The disease is characterized by involvement of the posterior limb of the internal capsule and by globus pallidus. Cerebral hemisphere, cerebellum, spinal cord, cranial nerves and peripheral nerves may also be affected. Atrophy of the brainstem and/or cerebellum without appreciable volume loss in the cerebrum can be observed in the chronic stage of NBD.
In the non-parenchymal group, CNS dysfunction is due to involvement of major vessels (vascular NBD), aseptic meningitis or, in rare circumstantces,peripheral neuropathy. Vascular NBD usually presents with isolated intracranial hypertension associated with dural venous sinus thrombosis and detected by MR venography (MRV). Arterial thrombosis and aneurysm formation are rarely seen in this disease.
Diffusion weighted imaging (DWI) and proton MR spectroscopy (MRS) are useful in differentiating parenchymal neuro-Behcet's disease from acute infarction. The periventricular ovoid lesions seen in patients with MS and subcortical lesions in patients with SLE are not common in NBD.
The distinct MRI findings of NBD can help to differentiate it from other neurological disorders.
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