[Neurological manifestations of Behcet's disease: 22 cases among 170 patients]. / Etude de 22 observations de neuroBehçet dans une série de 170 maladies de Behçet.

OBJECTIVES: To present neurological involvement in Behçet's disease, its prognosis and treatment. METHODS: Our study was retrospective and was done at Hotel-Dieu Hospital of Beirut between 1980 and 2005. All these patients fulfilled the International Study Group criteria for diagnosis of Behçet's disease. RESULTS: Neurological involvement was observed in 13% (22/170) of our patients and was more frequent in men (sex-ratio: 1,75). The mean age of onset for Behçet's disease and NeuroBehçet's syndrome was 26+/-6 and 30+/-8 years respectively. Central nervous system involvement was found in 21 patients and peripheral nervous system involvement in one. Meningoencephalitis and/or transverse myelitis were found in 57% (12/21) of cases (in association with brainstem syndrome in 2 of these cases), brainstem syndrome without meningoencephalitis in 5 cases, tumor-like syndrome in 2 cases, repetitive ischemic attacks in 1 case and cerebral venous thrombosis in one. Focal deficits were the major presenting signs (16 cases) and external oculomotor nerve paralysis was observed in 4 patients. In meningoencephalitis, the cerebrospinal fluid findings were lymphocytic pleocytosis and elevated protein level. CT Scan, performed in 6 patients, was normal in 33% of cases. MRI, performed in 9 patients, was abnormal in 6 and showed abnormal signals distributed over the brainstem and the thalamus in 4, a tumor-like lesion and thrombosis of the left lateral sinus one each. Corticosteroids were usually efficacious but, when used alone, relapse was observed in 31% of patients. One patient who had brainstem syndrome died within 18 months because of a delayed corticosteroid treatment. CONCLUSION: Within central neurological involvement in Behçet's disease, we can individualize 4 clinical aspects: meningoencephalitis (and/or myelitis), brainstem syndrome, tumor-like features and cerebral venous thrombosis. Abnormalities, observed on CT Scan and MRI, by their brainstem localization and their multiplicity, should evoke the diagnosis. Corticosteroids, when prescribed early, are useful and are associated with better prognosis; their association to immunosuppressant agents should be considered in the parenchymatous forms.

[Human brucellosis in Lebanon. Clinical features and therapeutic responses in 88 patients]. / Brucellose humaine au Liban. Etude clinique et thérapeutique de 88 patients.

OBJECTIVES: Present clinical features of brucellosis in Lebanon. METHODS: Eighty-eight patients were seen at Hotel-Dieu de France Hospital of Beirut between 1994 and 2002. Diagnostic criteria were brucellar agglutinins at a titer; 1/160 with symptoms suggestive of brucellosis in the absence of other diagnosis and a therapeutic response. RESULTS: Out of the 88 hospitalized patients, 11 pediatric cases are noted. The disease is acute in 58 (66%), subacute in 28 (32%) and chronic in 2. The main presenting symptoms are fever, sweating, easy fatigability and diffuse aches. Osteoarticular involvement is the most prevalent complication (28%) and spondylitis is seen in 44% of these cases. Meningoencephalitis is the most frequent neurological manifestation. Among the haematological tests, relative lymphocytosis is significantly more frequent in children than adults (73% vs 19% ; p < 0,001) and in the acute form than the subacute (36% vs 7%; p < 0,001) whereas leucocytosis is more frequent in the subacute form (21% vs 7%; p < 0,01). CONCLUSION: Brucellosis is still an endemic disease in Lebanon and should be systematically evoked in the case of prolonged fever, articular and neurological manifestations.

Vascular manifestations of Behçet's disease. Eighteen cases among 140 patients.

OBJECTIVES: To describe the features, prognosis, and treatment of vascular involvement in Behçet's disease (BD). PATIENTS: Among 140 patients with BD seen at the Hôtel-Dieu Hospital in Beirut between 1980 and 2000, 18 (13%) had vascular involvement and were included in this retrospective study. All these patients fulfilled International Study Group criteria for BD. RESULTS: Men with BD were more likely to have vascular involvement (13/77, 17%) than women (5/63, 8%) (P = 0.12) and were younger at diagnosis of vascular disease (32 +/- 7 vs. 36 +/- 7.5 years; P < 0.01). Many patients had vascular disease at more than one site: 17 had thrombophlebitis, 10 had arterial thromboses, and one had an aneurysm. Thrombophlebitis was more common in men (82% vs. 18%; P < 0.03) and arterial occlusion in women (70% vs. 30%; P > 0.05). Caval thrombosis and arterial occlusions were the most serious complications. Combined treatment with glucocorticoids, anticoagulants, and immunosuppressants was effective in superior vena cava syndrome and extracranial arterial occlusion. CONCLUSION: Vascular manifestations of BD are common in Lebanon, particularly venous lesions. Aneurysms are seen less often than arterial occlusions. Medical treatment may be sufficient in superior vena cava syndrome and arterial occlusion.