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Neuro-Behçet's disease

January 01, 1970

Behçet's disease is recognized as a disease that cause inflammatory perivasculitis, inflammation of the tissue around a blood or lymph vessel, in practically any tissue in the body. Usually, prevalent symptoms include canker sores or ulcers in the mouth and on the genitals, and inflammation in parts of the eye.[1] In addition, patients experience severe headache and papulopustular skin lesions as well. The disease was first described in 1937 by a Turkish dermatologist, Dr. Hulusi Behçet. Behçet's disease is most prevalent in the Middle East and the Far East regions; however, it is rare in America regions.[2]

Neuro-Behçet's disease
SpecialtyNeurology

Behçet's disease with neurological involvement, neuro-Behçet's disease (NBD), involves central nervous system damage in 5–50% of cases.[3] The high variation in the range is due to study design, definition of neurological involvement, ethnic or geographic variation, availability of neurological expertise and investigations, and treatment protocols.

Signs and symptoms edit

The initial signs and symptoms of NBD are usually very general. This makes NBD hard to diagnose until the patients experience severe neurological damage. In addition, the combination of symptoms varies among patients.

Parenchymal Neuro-Behçet's Disease edit

The main symptom of NBD is meningoencephalitis, with a prevalence of ~75% in NBD patients. Other general symptoms of Behçet's disease are also present among Parenchymal NBD patients such as genital ulcers, skin lesions and ocular involvement. When the brainstem is affected, ophthalmoparesis, cranial neuropathy, and cerebellar or pyramidal dysfunction may be observed. Cerebral hemispheric involvement may result in encephalopathy, hemiparesis, hemisensory loss, seizures, dysphasia, and mental changes including cognitive dysfunction and psychosis. As for spinal cord involvement, pyramidal signs in the limbs, sensory level dysfunction, and, commonly, sphincter dysfunction may be observed.

Some of the less common symptoms include stroke (1.5%), epilepsy (2.2–5%), brain tumor, movement disorder, acute meningeal syndrome, and optic neuropathy.

Non-parenchymal neuro-Behçet's disease edit

Because Non-parenchymal NBD targets vascular structures, the symptoms arise in the same area. The main clinical characteristic is cerebral venous thrombosis (CVT). If one experiences CVT, a clot in one of the blood vessels of the brain blocks the blood flow and may result in stroke. This happens in the dural venous sinuses. Stroke-like symptoms such as confusion, weakness, and dizziness may be monitored. Headache tends to worsen over the period of several days.

Some of the less common symptoms include intracranial hypertension and intracranial aneurysms.

Causes edit

Because the cause of Behçet's disease is unknown, the cause responsible for neuro-Behçet's disease is unknown as well. Inflammation starts mainly due to immune system failure. However, no one knows what factors trigger the initiation of auto-immune disease like inflammation. Because the cause is unknown, it is impossible to eliminate or prevent the source that causes the disease. Therefore, treatments are focused on how to suppress the symptoms that hinder daily life activities.[4]

Diagnosis edit

Although there is a diagnostic criteria for Behçet's disease, one for neuro-Behçet's disease does not exist. Three diagnostic tools are mainly used.

Blood test edit

There is no serum biomarker to detect the disease, but raised erythrocyte sedimentation rate correlates with disease activity. [5] 60–70% of Japanese and Turkish patients were tested to possess HLA-B51, HLA-B serotype. These patients showed 6 times risk of getting BD. However, the same criteria are not ideal to be applied for Europeans because only 10–20% of European patients showed to possess HLA-B51.

Cerebrospinal fluid level edit

Cerebrospinal fluid is a clear bodily fluid that occupies the subarachnoid space and the ventricular system around and inside the brain. It is revealed that 70–80% of Parenchymal NBD patients show altered CSF constituents. The observed different is 1) Elevated CSF protein concentration (1 g/dL), 2) Absence of oligoclonal band, and 3) elevated CSF cell count (0–400×106 cells/L) in the body.

Others edit

"...Despite its rarity, the patient's ethnic background and the typical radiographic findings should prompt the clinicians to include NBD in the differential diagnosis of optic neuritis and demyelinating disease in the young..."[5][citation needed]. This quote indicates that even common symptoms such as headache should be recognized as the sign for possible NBD considering the patient's ethnic background.

Types edit

There are two types of neuro-Behçet's disease: parenchymal and non-parenchymal. The two types of neuro-Behçet's disease rarely occur in the same person. It is suggested that the pathogenesis of the two types are probably different.[3] Statistics indicate that approximately 75% (772 of 1031) BD patients advanced to parenchymal NBD while 17.7% (183 of 1031) of BD patients advanced to non-parenchymal NBD. The remaining 7.3% were not able to be categorized.

Parenchymal edit

If one experiences parenchymal neuro-Behçet's disease, meningoencephalitis, inflammation of brain, primarily occurs. The target areas of parenchymal NBD include brainstem, spinal cord, and cerebral regions. Sometimes it is hard to determine the affected area because patients are asymptomatic.[6]

Non-parenchymal edit

In non-parenchymal NBD, vascular complications such as cerebral venous thrombosis primarily occurs. Other distinct characteristics include intracranial aneurysm and extracranial aneurysm. In most cases, veins are much more likely to be affected than arteries. Venous sinus thrombosis is the most frequent vascular manifestation in NBD followed by cortical cerebral veins thrombosis. On the other hand, thrombosis and aneurysms of the large cerebral arteries are rarely reported.[7]

Others edit

Peripheral nervous system involvement is rarely reported (~0.8%). In this case, Guillain–Barré syndrome, sensorimotor neuropathy, mononeuritis multiplex, autonomic neuropathy, and subclinical nerve-conduction abnormalities are observed.

Some of the syndromes are not common but recognized for the relation to NBD such as acute meningeal syndrome, tumor-like neuro-Behçet's disease, psychiatric symptoms and optic neuropathy.

Treatment edit

No definite standard treatment have been set. This is because treatments of the disease has been poorly studied as of 2014.[8] Often in cases of inflammatory parenchymal disease, "corticosteroids should be given as infusions of intravenous methylprednisolone followed by a slowly tapering course of oral steroids". It is suggested that therapy should be continued for a period of time even when the symptoms get suppressed because early relapse may occur. Sometimes, the medical doctors may suggest a different steroid depending on the nature of the disease, the severity, and the response to steroids. According to several studies, parenchymal NBD patients successfully suppress the symptoms with the prescribed steroids. As for non-parenchymal patients, there is no general consensus on how to treat the disease. The reason is that the mechanisms of cerebral venous thrombosis in BD are still poorly understood. Some doctors use anti-coagulants to prevent a clot. On the other hand, some doctors only give steroids and immunosuppressants alone.[9][10]

Epidemiology edit

In one study of 387 Behçet's disease (BD) patients that has been done for 20 years, 13% of men with BD developed to NBD and 5.6% of women developed to NBD. Combining all statistical reports, approximately 9.4% (43 of 459) BD patients advanced to NBD. In addition, men were 2.8 times more likely to experience NBD than women. This fact indicates possible gender-based pathology.[11][12][13] In speaking about age of NBD patients, the general range was between 20 and 40. NBD patients with age less than 10 or more than 50 were very uncommon.

Spectrum disorders edit

A related disorder to Neuro-Behçet's disease is neuro-Sweet disease.[14] Sweet disease (or acute febrile neutrophilic dermatosis) is a systemic inflammatory disorder characterized by fever, peripheral neutrophilic leukocytosis, and neutrophilic infiltrates in the skin, among other symptoms.[15] When complicated by encephalitis or meningitis, it is referred to as neuro-Sweet disease. It is known that treatment with corticosteroids often leads to favorable outcomes. The frequencies of the human leukocyte antigen (HLA) types B54 and Cw1 are notably high. Several risk factors, including these, are implicated in the development of the condition. Although neuro-Behçet's disease differs in terms of the more common HLA types, it is believed to constitute a spectrum of disorders with shared underlying risk factors.[16]

References edit

  1. ^ Serdaroflu P, Yazici H, Ozdemir C, Yurdakul S, Bahar S, Aktin E (1989). "Neurologic involvement in Behçet's syndrome. A prospective study". Arch Neurol. 46 (3): 265–269. doi:10.1001/archneur.1989.00520390031011. PMID 2919979.
  2. ^ Yazici H, Fresko I, Yurdakul S (2007). "Behçet's syndrome: disease manifestations, management, and advances in treatment". Nat Clin Pract Rheumatol. 3 (3): 148–55. doi:10.1038/ncprheum0436. PMID 17334337. S2CID 21869670.
  3. ^ Farah S, Al-Shubaili A, Montaser A (1998). "Behçet's syndrome: a report of 41 patients with emphasis on neurological manifestations". J Neurol Neurosurg Psychiatry. 64 (3): 382–84. doi:10.1136/jnnp.64.3.382. PMC 2169980. PMID 9527155.
  4. ^ Akman-Demir G; Serdaroglu P; Tasçi B; Study Group Neuro-Behçet (1999). "Clinical patterns of neurological involvement in Behçet's disease: evaluation of 200 patients". Brain. 122 (11): 2171–2182. doi:10.1093/brain/122.11.2171. PMID 10545401.
  5. ^ Kidd DP (October 2023). "Neurological involvement by Behçet's syndrome: clinical features, diagnosis, treatment and outcome". Pract Neurol. 23 (5): 386–400. doi:10.1136/pn-2023-003875. PMID 37775123.
  6. ^ Kidd D, Steuer A, Denman AM, Rudge P (1999). "Neurological complications of Behçet's syndrome". Brain. 122 (11): 2183–94. doi:10.1093/brain/122.11.2183. PMID 10545402.
  7. ^ Tunc R, Saip S, Siva A, Yazici H. Cerebral venous thrombosis is associated with major vessel disease in Behçet's syndrome. Ann Rheum Dis 2004; 63: 1693–94.
  8. ^ Nava, F; Ghilotti, F; Maggi, L; Hatemi, G; Del Bianco, A; Merlo, C; Filippini, G; Tramacere, I (18 December 2014). "Biologics, colchicine, corticosteroids, immunosuppressants and interferon-alpha for Neuro-Behçet's Syndrome". The Cochrane Database of Systematic Reviews. 12 (12): CD010729. doi:10.1002/14651858.CD010729.pub2. PMC 10594584. PMID 25521793.
  9. ^ Akman-Demir G, Serdaroglu P, Tasçi B (1999). "Clinical patterns of neurological involvement in Behçet's disease: evaluation of 200 patients. The Neuro-Behçet Study Group". Brain. 122: 2171–82. doi:10.1093/brain/122.11.2171. PMID 10545401.
  10. ^ Al-Fahad S, Al-Araji A (1999). "Neuro-Behçet's disease in Iraq: a study of 40 patients". J Neurol Sci. 170 (2): 105–11. doi:10.1016/s0022-510x(99)00165-3. PMID 10561525. S2CID 24943648.
  11. ^ Sorgun, Mine Hayriye; Kural, Mustafa Aykut; Yucesan, Canan (2018). "Clinical characteristics and prognosis of Neuro-Behçet's disease". European Journal of Rheumatology. 5 (4): 235–239. doi:10.5152/eurjrheum.2018.18033. PMC 6267754. PMID 30308139.
  12. ^ Ashjazadeh N, Borhani Haghighi A, Samangooie S, Moosavi H (2003). "Neuro-Behçet's disease: a masquerader of multiple sclerosis. A prospective study of neurologic manifestations of Behçet's disease in 96 Iranian patients". Exp Mol Pathol. 74 (1): 17–22. doi:10.1016/S0014-4800(03)80004-7. PMID 12645628.
  13. ^ Al-Araji A, Sharquie K, Al-Rawi Z (2003). "Prevalence and patterns of neurological involvement in Behçet's disease: a prospective study from Iraq". J Neurol Neurosurg Psychiatry. 74 (5): 608–13. doi:10.1136/jnnp.74.5.608. PMC 1738436. PMID 12700303.
  14. ^ Hisanaga, K.; Iwasaki, Y.; Itoyama, Y.; Neuro-Sweet Disease Study Group (2005). "Neuro-Sweet disease: Clinical manifestations and criteria for diagnosis". Neurology. 64 (10): 1756–1761. doi:10.1212/01.WNL.0000161848.34159.B5. PMID 15911805. S2CID 20773636.
  15. ^ Sweet, R. B. (1964). "An Acute Febrile Neutrophtlic Dermatosts". British Journal of Dermatology. 76 (8–9): 349–356. doi:10.1111/j.1365-2133.1964.tb14541.x. PMID 14201182. S2CID 53772268.
  16. ^ Hisanaga, Kinya (2022). "Neuro-Behçet Disease, Neuro-Sweet Disease, and Spectrum Disorders". Internal Medicine. 61 (4): 447–450. doi:10.2169/internalmedicine.8227-21. PMC 8907766. PMID 34615825.

Further reading edit

  • Al-Araji, A; Kidd, DP (February 2009). "Neuro-Behçet's disease: epidemiology, clinical characteristics, and management". Lancet Neurology. 8 (2): 192–204. doi:10.1016/S1474-4422(09)70015-8. PMID 19161910. S2CID 16483117.
  • Koçer, N; Islak, C; Siva, A; Saip, S; Akman, C; Kantarci, O; Hamuryudan, V (Jun–Jul 1999). "CNS involvement in neuro-Behçet syndrome: an MR study". AJNR. American Journal of Neuroradiology. 20 (6): 1015–24. PMC 7056254. PMID 10445437.
  • Borhani Haghighi, A (April 2009). "Treatment of neuro-Behçet's disease: an update". Expert Review of Neurotherapeutics. 9 (4): 565–74. doi:10.1586/ern.09.11. PMID 19344307. S2CID 136810719.

January 01, 1970
neuro, behçet, disease, this, article, needs, additional, citations, verification, please, help, improve, this, article, adding, citations, reliable, sources, unsourced, material, challenged, removed, find, sources, news, newspapers, books, scholar, jstor, apr. This article needs additional citations for verification Please help improve this article by adding citations to reliable sources Unsourced material may be challenged and removed Find sources Neuro Behcet s disease news newspapers books scholar JSTOR April 2017 Learn how and when to remove this message Behcet s disease is recognized as a disease that cause inflammatory perivasculitis inflammation of the tissue around a blood or lymph vessel in practically any tissue in the body Usually prevalent symptoms include canker sores or ulcers in the mouth and on the genitals and inflammation in parts of the eye 1 In addition patients experience severe headache and papulopustular skin lesions as well The disease was first described in 1937 by a Turkish dermatologist Dr Hulusi Behcet Behcet s disease is most prevalent in the Middle East and the Far East regions however it is rare in America regions 2 Neuro Behcet s diseaseSpecialtyNeurology Behcet s disease with neurological involvement neuro Behcet s disease NBD involves central nervous system damage in 5 50 of cases 3 The high variation in the range is due to study design definition of neurological involvement ethnic or geographic variation availability of neurological expertise and investigations and treatment protocols Contents 1 Signs and symptoms 1 1 Parenchymal Neuro Behcet s Disease 1 2 Non parenchymal neuro Behcet s disease 2 Causes 3 Diagnosis 3 1 Blood test 3 2 Cerebrospinal fluid level 3 3 Others 3 4 Types 3 4 1 Parenchymal 3 4 2 Non parenchymal 3 4 3 Others 4 Treatment 5 Epidemiology 6 Spectrum disorders 7 References 8 Further readingSigns and symptoms editThe initial signs and symptoms of NBD are usually very general This makes NBD hard to diagnose until the patients experience severe neurological damage In addition the combination of symptoms varies among patients Parenchymal Neuro Behcet s Disease edit The main symptom of NBD is meningoencephalitis with a prevalence of 75 in NBD patients Other general symptoms of Behcet s disease are also present among Parenchymal NBD patients such as genital ulcers skin lesions and ocular involvement When the brainstem is affected ophthalmoparesis cranial neuropathy and cerebellar or pyramidal dysfunction may be observed Cerebral hemispheric involvement may result in encephalopathy hemiparesis hemisensory loss seizures dysphasia and mental changes including cognitive dysfunction and psychosis As for spinal cord involvement pyramidal signs in the limbs sensory level dysfunction and commonly sphincter dysfunction may be observed Some of the less common symptoms include stroke 1 5 epilepsy 2 2 5 brain tumor movement disorder acute meningeal syndrome and optic neuropathy Non parenchymal neuro Behcet s disease edit Because Non parenchymal NBD targets vascular structures the symptoms arise in the same area The main clinical characteristic is cerebral venous thrombosis CVT If one experiences CVT a clot in one of the blood vessels of the brain blocks the blood flow and may result in stroke This happens in the dural venous sinuses Stroke like symptoms such as confusion weakness and dizziness may be monitored Headache tends to worsen over the period of several days Some of the less common symptoms include intracranial hypertension and intracranial aneurysms Causes editBecause the cause of Behcet s disease is unknown the cause responsible for neuro Behcet s disease is unknown as well Inflammation starts mainly due to immune system failure However no one knows what factors trigger the initiation of auto immune disease like inflammation Because the cause is unknown it is impossible to eliminate or prevent the source that causes the disease Therefore treatments are focused on how to suppress the symptoms that hinder daily life activities 4 Diagnosis editAlthough there is a diagnostic criteria for Behcet s disease one for neuro Behcet s disease does not exist Three diagnostic tools are mainly used Blood test edit There is no serum biomarker to detect the disease but raised erythrocyte sedimentation rate correlates with disease activity 5 60 70 of Japanese and Turkish patients were tested to possess HLA B51 HLA B serotype These patients showed 6 times risk of getting BD However the same criteria are not ideal to be applied for Europeans because only 10 20 of European patients showed to possess HLA B51 Cerebrospinal fluid level edit Cerebrospinal fluid is a clear bodily fluid that occupies the subarachnoid space and the ventricular system around and inside the brain It is revealed that 70 80 of Parenchymal NBD patients show altered CSF constituents The observed different is 1 Elevated CSF protein concentration 1 g dL 2 Absence of oligoclonal band and 3 elevated CSF cell count 0 400 106 cells L in the body Others edit Despite its rarity the patient s ethnic background and the typical radiographic findings should prompt the clinicians to include NBD in the differential diagnosis of optic neuritis and demyelinating disease in the young 5 citation needed This quote indicates that even common symptoms such as headache should be recognized as the sign for possible NBD considering the patient s ethnic background Types edit There are two types of neuro Behcet s disease parenchymal and non parenchymal The two types of neuro Behcet s disease rarely occur in the same person It is suggested that the pathogenesis of the two types are probably different 3 Statistics indicate that approximately 75 772 of 1031 BD patients advanced to parenchymal NBD while 17 7 183 of 1031 of BD patients advanced to non parenchymal NBD The remaining 7 3 were not able to be categorized Parenchymal edit If one experiences parenchymal neuro Behcet s disease meningoencephalitis inflammation of brain primarily occurs The target areas of parenchymal NBD include brainstem spinal cord and cerebral regions Sometimes it is hard to determine the affected area because patients are asymptomatic 6 Non parenchymal edit In non parenchymal NBD vascular complications such as cerebral venous thrombosis primarily occurs Other distinct characteristics include intracranial aneurysm and extracranial aneurysm In most cases veins are much more likely to be affected than arteries Venous sinus thrombosis is the most frequent vascular manifestation in NBD followed by cortical cerebral veins thrombosis On the other hand thrombosis and aneurysms of the large cerebral arteries are rarely reported 7 Others edit Peripheral nervous system involvement is rarely reported 0 8 In this case Guillain Barre syndrome sensorimotor neuropathy mononeuritis multiplex autonomic neuropathy and subclinical nerve conduction abnormalities are observed Some of the syndromes are not common but recognized for the relation to NBD such as acute meningeal syndrome tumor like neuro Behcet s disease psychiatric symptoms and optic neuropathy Treatment editNo definite standard treatment have been set This is because treatments of the disease has been poorly studied as of 2014 8 Often in cases of inflammatory parenchymal disease corticosteroids should be given as infusions of intravenous methylprednisolone followed by a slowly tapering course of oral steroids It is suggested that therapy should be continued for a period of time even when the symptoms get suppressed because early relapse may occur Sometimes the medical doctors may suggest a different steroid depending on the nature of the disease the severity and the response to steroids According to several studies parenchymal NBD patients successfully suppress the symptoms with the prescribed steroids As for non parenchymal patients there is no general consensus on how to treat the disease The reason is that the mechanisms of cerebral venous thrombosis in BD are still poorly understood Some doctors use anti coagulants to prevent a clot On the other hand some doctors only give steroids and immunosuppressants alone 9 10 Epidemiology editIn one study of 387 Behcet s disease BD patients that has been done for 20 years 13 of men with BD developed to NBD and 5 6 of women developed to NBD Combining all statistical reports approximately 9 4 43 of 459 BD patients advanced to NBD In addition men were 2 8 times more likely to experience NBD than women This fact indicates possible gender based pathology 11 12 13 In speaking about age of NBD patients the general range was between 20 and 40 NBD patients with age less than 10 or more than 50 were very uncommon Spectrum disorders editA related disorder to Neuro Behcet s disease is neuro Sweet disease 14 Sweet disease or acute febrile neutrophilic dermatosis is a systemic inflammatory disorder characterized by fever peripheral neutrophilic leukocytosis and neutrophilic infiltrates in the skin among other symptoms 15 When complicated by encephalitis or meningitis it is referred to as neuro Sweet disease It is known that treatment with corticosteroids often leads to favorable outcomes The frequencies of the human leukocyte antigen HLA types B54 and Cw1 are notably high Several risk factors including these are implicated in the development of the condition Although neuro Behcet s disease differs in terms of the more common HLA types it is believed to constitute a spectrum of disorders with shared underlying risk factors 16 References edit Serdaroflu P Yazici H Ozdemir C Yurdakul S Bahar S Aktin E 1989 Neurologic involvement in Behcet s syndrome A prospective study Arch Neurol 46 3 265 269 doi 10 1001 archneur 1989 00520390031011 PMID 2919979 Yazici H Fresko I Yurdakul S 2007 Behcet s syndrome disease manifestations management and advances in treatment Nat Clin Pract Rheumatol 3 3 148 55 doi 10 1038 ncprheum0436 PMID 17334337 S2CID 21869670 Farah S Al Shubaili A Montaser A 1998 Behcet s syndrome a report of 41 patients with emphasis on neurological manifestations J Neurol Neurosurg Psychiatry 64 3 382 84 doi 10 1136 jnnp 64 3 382 PMC 2169980 PMID 9527155 Akman Demir G Serdaroglu P Tasci B Study Group Neuro Behcet 1999 Clinical patterns of neurological involvement in Behcet s disease evaluation of 200 patients Brain 122 11 2171 2182 doi 10 1093 brain 122 11 2171 PMID 10545401 Kidd DP October 2023 Neurological involvement by Behcet s syndrome clinical features diagnosis treatment and outcome Pract Neurol 23 5 386 400 doi 10 1136 pn 2023 003875 PMID 37775123 Kidd D Steuer A Denman AM Rudge P 1999 Neurological complications of Behcet s syndrome Brain 122 11 2183 94 doi 10 1093 brain 122 11 2183 PMID 10545402 Tunc R Saip S Siva A Yazici H Cerebral venous thrombosis is associated with major vessel disease in Behcet s syndrome Ann Rheum Dis 2004 63 1693 94 Nava F Ghilotti F Maggi L Hatemi G Del Bianco A Merlo C Filippini G Tramacere I 18 December 2014 Biologics colchicine corticosteroids immunosuppressants and interferon alpha for Neuro Behcet s Syndrome The Cochrane Database of Systematic Reviews 12 12 CD010729 doi 10 1002 14651858 CD010729 pub2 PMC 10594584 PMID 25521793 Akman Demir G Serdaroglu P Tasci B 1999 Clinical patterns of neurological involvement in Behcet s disease evaluation of 200 patients The Neuro Behcet Study Group Brain 122 2171 82 doi 10 1093 brain 122 11 2171 PMID 10545401 Al Fahad S Al Araji A 1999 Neuro Behcet s disease in Iraq a study of 40 patients J Neurol Sci 170 2 105 11 doi 10 1016 s0022 510x 99 00165 3 PMID 10561525 S2CID 24943648 Sorgun Mine Hayriye Kural Mustafa Aykut Yucesan Canan 2018 Clinical characteristics and prognosis of Neuro Behcet s disease European Journal of Rheumatology 5 4 235 239 doi 10 5152 eurjrheum 2018 18033 PMC 6267754 PMID 30308139 Ashjazadeh N Borhani Haghighi A Samangooie S Moosavi H 2003 Neuro Behcet s disease a masquerader of multiple sclerosis A prospective study of neurologic manifestations of Behcet s disease in 96 Iranian patients Exp Mol Pathol 74 1 17 22 doi 10 1016 S0014 4800 03 80004 7 PMID 12645628 Al Araji A Sharquie K Al Rawi Z 2003 Prevalence and patterns of neurological involvement in Behcet s disease a prospective study from Iraq J Neurol Neurosurg Psychiatry 74 5 608 13 doi 10 1136 jnnp 74 5 608 PMC 1738436 PMID 12700303 Hisanaga K Iwasaki Y Itoyama Y Neuro Sweet Disease Study Group 2005 Neuro Sweet disease Clinical manifestations and criteria for diagnosis Neurology 64 10 1756 1761 doi 10 1212 01 WNL 0000161848 34159 B5 PMID 15911805 S2CID 20773636 Sweet R B 1964 An Acute Febrile Neutrophtlic Dermatosts British Journal of Dermatology 76 8 9 349 356 doi 10 1111 j 1365 2133 1964 tb14541 x PMID 14201182 S2CID 53772268 Hisanaga Kinya 2022 Neuro Behcet Disease Neuro Sweet Disease and Spectrum Disorders Internal Medicine 61 4 447 450 doi 10 2169 internalmedicine 8227 21 PMC 8907766 PMID 34615825 Further reading editAl Araji A Kidd DP February 2009 Neuro Behcet s disease epidemiology clinical characteristics and management Lancet Neurology 8 2 192 204 doi 10 1016 S1474 4422 09 70015 8 PMID 19161910 S2CID 16483117 Kocer N Islak C Siva A Saip S Akman C Kantarci O Hamuryudan V Jun Jul 1999 CNS involvement in neuro Behcet syndrome an MR study AJNR American Journal of Neuroradiology 20 6 1015 24 PMC 7056254 PMID 10445437 Borhani Haghighi A April 2009 Treatment of neuro Behcet s disease an update Expert Review of Neurotherapeutics 9 4 565 74 doi 10 1586 ern 09 11 PMID 19344307 S2CID 136810719 Retrieved from https en wikipedia org w index php title Neuro Behcet 27s disease amp oldid 1223049727, wikipedia, wiki, book, books, library,

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