Recurrent Stroke Presentation in Neuro-Behcet Disease: Clinical Insights from a Case Report

Behcet disease is a form of multisystemic vasculitis, a rare and consequential manifestation of it, known as neuro-Behcet disease (NBD), associated with higher morbidity. We present a 32-year-old man with an ischemic stroke presentation as the initial sign of NBD. The presenting symptoms involved right-sided hemisensory loss associated with mild weakness, headache, dizziness, and gait imbalance, suggestive of a stroke. Initial computed tomography suggested a left thalamic infarction; subsequent magnetic resonance imaging revealed an irregular, ring-enhancing left thalamic lesion, raising concern for infectious or neoplastic causes. Extensive investigations ruled out infectious and neoplastic etiologies. Following the exclusion of other causes, the patient was managed with high-dose intravenous corticosteroids and then discharged on oral therapy for later outpatient follow-up. However, on discontinuing his medications, he presented with acute neurological symptoms indicating a recurrent ischemic stroke. This case highlights the importance of broad differential diagnosis in young patients presenting with stroke-like symptoms, as it can be a rare initial presentation of NBD. Furthermore, it also underscores the need for close follow-up and medication adherence in NBD patients, as relapse can lead to disabling and lifelong complications, as exemplified by our patient's second stroke.