Cerebral Venous Thrombosis as the Initial Presentation of Behcet’s Disease.docVIP

Case Report 220 Cerebral Venous Thrombosis as the Initial Presentation of Behcet’s Disease Ali Ibrahim Rahil, MD; Mehdi Errayes, MD; Khaled M. Salem1, MD Neurological symptoms are rare manifestations of Behcet’s disease. In this paper, we report cerebral venous thrombosis as the initial presentation of Behcet’s disease in a 40 year- old man. Our patient presented with a six-week history of headache, progressive loss of vision in the right eye and recurrent oral ulcers. Physical examination revealed oral ulcers and posterior synechia in the right eye with loss of light perception. Fundoscopic examina- tion showed evidence of retinal vasculitis. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of the brain showed superior sagittal, left transverse, and left sigmoid sinus venous thrombosis. A diagnosis of Behcet’s disease was made based on clini- cal criteria. Treatment with methylpredinsolone, cyclophosphamide, and azathioprine as well as anticoagulation was done with significant clinical improvement. (Chang Gung Med J 2009;32:220-3) Key words: Beh?et’s disease, cerebral venous thrombosis B ehcet’s disease is a chronic relapsing inflamma- tory disease that was first described by the Turkish dermatologist Hulusi Behcet in 1936. However, the disease might have been recognized the tongue and soft palate, and evidence of posterior synechia in the right eye with loss of light percep- tion. Fundus examination showed bilateral papillede- ma along with retinal hemorrhage and exudates. The remainder of the physical examination was unre- markable. Initial laboratory tests showed hemoglobin 8.2 gm/dl, white blood cells (WBC) 26,000/μL, (mainly neutrophils), and platelets 484,000/μl. A peripheral blood smear showed normocytic normochromic ane- mia with target cells and neutophilic leukocytosis. Biochemical data showed alkaline phosphatase 210 U/L (Normal: 40-129),