Neuro-Behcet's syndrome in a patient not fulfilling criteria for Behcet's disease: Clinical features and value of brain imaging

Central nervous system involvement is rarely an initial presenting manifest ation of Behcet's disease (BD). We report the case of a 33-year-old man wit h recurrent attacks of fever, oral mucosal ulcers, deep venous thrombosis, diplopia, vertigo and headache. Sequential brain magnetic resonance imaging (MRI) scans showed fluctuating lesions of the brain stem, mesencephalon an d thalamus. F-18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG -PET) revealed hypometabolism at the parieto-occipital cortex at both sides and the brain stem. Treatment with prednisone and cyclosporine A led to a complete remission and normalisation of MRI and FDG-PET lesions. The presen t case illustrates the difficulty in the differential diagnosis of early ne uro-BD.