[A case of neuro-Behcet's disease with transient cerebral ischemia evoked by smoking]

We present a 63-year-old male case of neuro-Behçet's disease with transient cerebral ischemia evoked by smoking. He first noticed genital ulcer after the operation of colon cancer, and then recurrent oral aphtha and skin erythema. From these symptoms and other laboratory data, we diagnosed him as suffering from Behçet's disease. He also showed dysbasia, dysarthria, pseudo-bulbar palsy, and changes in character, characteristic to neuro-Behçet's disease. After smoking, he showed disturbance of consciousness, dysequilibrium, and bilateral adynamia in upper and lower extremities, so we performed SPECT study. Compared with routine SPECT, less blood perfusion in frontal lobe, temporal lobe, and basal ganglia was observed after smoking. Mild vasculitis was observed in skin biopsy, but no such signs were observed in cerebral angiography. After steroid therapy, these symptoms evoked by smoking faded away. Previous studies reported that vasculitis is an important predisposing cause of vasospasm, and that smoking causes transient cerebral ischemia by vasospastic mechanisms. In this case, mild vasculitis was thought to be predisposed to vasospasm by smoking.