A case of Neuro-Behcet disease which initially mimicked lateral medullary infarct

초록

Background: We describe a rare case of neuro-Behcet disease which initially presented with Wallenberg syndrome-like features. Case Description: A 41-year-old man visited our hospital for a suddenly developed dysarthria, which developed a few days ago. He denied any stroke risk factor. On neurologic exam, hemihypethesia in left body and dysmetria in the right upper extremity was noticed. T2-weighted MR image showed a small high signal intensity lesion in dorsolateral medulla with pontine extension. Definite signal change could not be found in the diffusion-weighted image due to the artifacts in the lower brainstem. Though this patient did not show the complete neurologic features of Wallenberg syndrome, we thought him to have lateral medullary infarct, as he showed crossed lateralizing sign and also there was a small lesion in the medulla on MRI. We prescribed aspirin for the secondary prevention and his symptom improved over time. He has been in good health until six months later when he developed sudden onset horizontal diplopia. Follow-up MRI showed a high signal intensity lesion in paramedian midbrain area on T2 weighted image, and the previous medullary lesion disappeared. CSF exam showed mild pleocytosis and elevated protein content. Repeated history taking revealed that he had been suffered from recurrent oral and genital ulcer for 10 years. Under the diagnosis of neuro-Behcet disease, we treated him with cotricosteroid and cyclosporine. His symptom completely disappeared 3 months later. Conclusion: This is the first case report of neuro-Behcet disease initially mimicked Wallenberg syndrome. We suggest that the neuro-Behcet disease can be included in the differential diagnosis of Wallenberg syndrome, especially when there is no definite vascular risk factor.