Cerebral venous thrombosis in Behcet's disease. A report on 24 cases.

INTRODUCTION: Cerebral venous thrombosis (CVT) is the most common manifestation of vasculo-Behçet's disease and may be superficial and/or deep localization. The aim of our study was to evaluate the clinical and radiological features of CVT associated with Behçet's disease in our population and to compare findings with previous studies. MATERIALS AND METHODS: We report a retrospective study of 24 cases of CVT secondary to Behçet's disease, collected between 1999 and 2019 in the neurology department of the Mohamed V Military Hospital (Rabat), the Avicenne Military Hospital (Marrakech) and the Mohamed VI Hospital (Marrakech). The diagnosis of Behçet's disease was made in all cases according to the 2014 International Study Group Criteria for Behçet diseases. Patients received antithrombotic treatment, combined with corticosteroids, in six cases of superficial CVT and with immunosuppressants in cases of deep CVT. RESULTS: Clinical manifestations were dominated by motor deficit in deep localizations and intracranial hypertension in superficial locations. The diencephalic-mesencephalic syndrome was found in 18 patients, whereas intracranial hypertension (71%) and headache (57%) were the most common presentations of superficial CVT. Unlike previous studies, magnetic resonance angiography and conventional angiography performed in our patients confirmed the predominance of deep venous thrombosis (18 cases), whereas superficial CVT was observed only in six cases. DISCUSSION: In our series, the benefit of conventional angiography was undeniable, by confirming the diagnosis of basal vein of Rosenthal thrombosis in 75% of our patients. Short-term outcome was favorable, but sequelae of CVT were noted in 20 patients (75%). The outcome of patients was commonly mRS 02, however 70% of patients presenting with deep CVT at the beginning had a poor outcome (mRS 03) and we did not record any case of venous thrombosis relapse.

Clinicoradiological and prognostic features of COVID-19-associated acute disseminated encephalomyelitis.

INTRODUCTION: The Covid-19 pandemic has resulted in a spark in interest in the subject given the high exposure rate to viral antigens in the form of infections and vaccines. It is expected that acute disseminated encephalomyelitis (ADEM) cases see a rise in incidence during this period. Given the plethora of Covid-19-related central nervous system (CNS) involvement, it is important to be aware of the varied presentations of ADEM. CASE REPORTS: In this paper, we report 3 cases of ADEM following Covid-19 infection. Patients presented with polyfocal neurological symptoms 6 to 18 days after respiratory symptoms onset. The diagnosis of Covid-19 was made based on nasal swab reverse transcriptase-polymerase chain reaction (RT-PCR) and chest computerized tomography (CT). DISCUSSION: These cases illustrate both classic and atypical presentations requiring exclusion of a spectrum of CNS conditions to be able to retain the diagnosis of ADEM. Consequently, we stress the importance of context, clinical examination and MRI findings in the differentials. In addition, we discuss workup, and particularly, the indication of brain biopsy. Also, the paper discusses options in therapy and the prognosis. The prognosis of covid-associated ADEM is dependent on the extent of pathology intrinsic to ADEM and the intrication of the prognosis of Covid-19 infection. CONCLUSION: The key message in these 3 cases is that clinicians should have a low threshold of suspicion of ADEM in the Covid-19 context, adopt appropriate workup strategies, and initiate adequate treatment for better outcomes.