Neuro-Behcet Disease Manifesting as Multiple Cerebral Aneurysms

A 69-year-old man was brought to the emergency department due to an acute onset of fever, altered mental status, and left motor deficit. Brain MRI disclosed bilateral acute and subacute strokes (figure, B). CSF identified aseptic meningitis. Extensive infectious workup was unremarkable. Cerebral angiography revealed more than 20 intracranial aneurysms, some fusiform (figure, A). Neuro-Behcet disease (NBD) was confirmed due to history of oral ulcers, positive pathergy test, and HLA-B51. Steroids were started with clinical response. NBD is very rarely associated with cerebral aneurysms, caused by obliterative endarteritis of the vaso vasorum.1,2 Multiple aneurysms and fever with no infectious cause should prompt investigation for NBD.

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