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Recurrent headaches: a case of neurological Behçet's disease
Alaa M Ismail1, Simon W Dubrey, Maneesh C Patel
1CT2 in the Department of Endocrinology, Hillingdon Hospital, Uxbridge, Middlesex.
British Journal of Hospital Medicine (London, England : 2005)
|October 10, 2013
Summary
This case study highlights a neurological flare-up in a patient with Behçet's disease, presenting with severe headache and gait instability. Prompt high-dose steroid therapy successfully reduced brainstem inflammation and improved symptoms.
Area of Science:
- Neuroimmunology
- Vascular Neurology
- Rheumatology
Background:
- Behçet's disease is a rare multisystem inflammatory disorder that can affect the central nervous system, leading to neurological complications.
- Neurological involvement in Behçet's disease can manifest as various symptoms, including headache, stroke, and gait disturbances.
- This case focuses on a patient with a history of Behçet's disease and a prior ischemic stroke, experiencing a recurrent neurological flare-up.
Observation:
- A 48-year-old male with Behçet's disease presented with a 24-hour history of migranous headache, blurred vision, and worsening unsteadiness on walking.
- Neurological examination revealed nystagmus, left hemiparesis, dysarthria, dysphonia, and exacerbated gait instability.
- Despite normal inflammatory markers (erythrocyte sedimentation rate), magnetic resonance imaging showed increased brainstem inflammation.
Findings:
- The patient experienced a significant neurological relapse characterized by severe headache and exacerbation of pre-existing neurological deficits.
- Magnetic resonance imaging confirmed a marked increase in brainstem inflammation, indicative of active Behçet's disease neuroinflammation.
- High-dose corticosteroid therapy, initiated immediately, led to a reduction in inflammation and clinical improvement.
Implications:
- This case underscores the importance of recognizing and promptly treating neurological flare-ups in Behçet's disease, even with normal inflammatory markers.
- Aggressive immunosuppressive therapy, particularly high-dose corticosteroids, can be effective in managing neuro-Behçet's disease activity.
- Early intervention and multidisciplinary management are crucial for improving outcomes and preventing further neurological damage in patients with neuro-Behçet's disease.
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