Behcet's disease presenting as intracranial hypertension due to cerebral venous thrombosis

The non-parenchymal central nervous system's (CNS) involvement in Behcet's disease (BD) is considered rare. We herein report a case of BD complicated by intracranial hypertension (ICH) due to cerebral venous thrombosis (CVT) in a 25-year-old Saudi male. Our patient presented with a four-week history of increasingly severe headache, nausea and diplopia, which were preceded by previous recurrent intermittent oral and genital ulcers, history suggestive of acneiform lesions and arthralgia over the past two years. Ophthalmic examination disclosed normal visual acuity (20/20) in both eyes with bilateral 6th nerve palsy and papilledema. Both eyes showed no signs of anterior or posterior segment inflammation. Oral and genital ulcers were found on physical examination with no other lesions. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of the brain showed lack of flow in the right transverse and sigmoid dural sinuses suggestive of venous thrombosis. On lumbar puncture, the opening pressure was greatly raised. After a comprehensive screening for prothrombotic conditions, a diagnosis of BD with ICH due to CVT was made. The patient was then treated by oral prednisolone, azathioprine, colchicine, cyclosporine, as well as anticoagulation, which resulted in significant clinical improvement.