Extending brainstem and capsule-thalamic lesions in a patient with parenchymal neuro-Behçet disease

A 44-year-old female patient with a history of recurrent oral and genital ulcers presented with rapid gait disturbance, headaches, dysphonia, dysphagia, and diplopia evolving for 3 weeks. On examination, spastic tetraparesis, cerebellar ataxia, and nerves palsies were noted. Pseudofolliculitis of the lower limbs and active buccal ulcers were identified. Cerebral MRI demonstrated T2-Flair hyperintense capsulothalamic lesion with midbrain and latero-protuberantial extension. The international criteria for the diagnosis of definite Neuro-Behçet’s disease (NBD) were met in our patient. Evolution under cyclophosphamide and intravenous methylprednisolone was favorable. The radiological findings in NBD are broad and challenging. Clinicians should be particularly suspicious of NBD in brain MRI with extensive lesions, involving the brainstem.