Long-term MR follow-up of cerebral lesions in neuro-Behcet's disease

To study the long-term evolution of cerebral lesions in neuro-Behcet's disease, MRI was carried out on 12 patients, with followup from 1.5 to 6 years (mean 3.5 years). On the first MRI, 66 lesions in all were found; each patient had 1-10 lesions (mean 5.5). There were 30 (46 %) lesions in the brain stem, 18 (27 %) in the basal ganglia region and 18 (27 %) in the periventricular white matter. Of these 22 (33 %) were small, 31 (47 %) medium-size and 13 (20 %) large lesions. On the last MRI, 60 lesions were found; each patient had 1-10 lesions (mean 5). At this time 31 lesions (52 %) were in the brain stem, 13 (22 %) in the basal ganglia region and 16 (26 %) in the periventricular white matter. There were 41 (68 %) small, 13 (22 %) medium-size and 6 (10 %) large lesions. About 40 % of the lesions disappeared, 35 % reduced in size and 25 % remained unchanged. No lesion had enlarged. Of the 60 final lesions 20 (34 %) were not observed on the first study. Small new lesions were found in 5 of 12 patients (42 %), and were asymptomatic. Medium-size or large new lesions were found in 2 patients (17 %) who had stopped steroid treatment and had a neurological relapse. Enlargement of the ventricular system or worsening of initial cerebral atrophy was observed in 9 of 12 patients. Appearance of small lesions and worsening of cerebral atrophy on long-term follow-up suggest the possibility of subclinical progression of cerebral vasculitis and should be considered in the prognosis of neuro-Behcet's disease.