MRI in Behçet's disease

Full text

Journal
of
Neurology,
Neurosurgery,
and
Psychiatry
1989;52:1212-122U
Matters
arising
MRI
in
Behcet's
disease
Sir:
The
paper
by
Besana
et
al'
underlines
the
contribution
that
MRI
is
making
to
a
wide
range
of
neurological
illnesses,
in
particular
multiple
sclerosis.
We
have
recently
reported
a
case
of
Behcet's
in
which
a
large
midbrain
mass
on
MRI
with
pressure
effects
disappeared
after
four
months
of
steroid
therapy.2
This
finding
has
prompted
us
to
add
further
to
the
discussion
by
Besani
et
al
on
the
origin
of
high
signal
lesions
on
MRI
in
their
two
cases.
High
signal
on
T2 weighted
images
may
commonly
result
from
increased
rho
(proton
density),
or
increased
T2.
Both
of
these
occur
in
experimental
oedema3
and
gliosis.4
The
resolving
lesion
we
observed
was
most
likely
due
to
oedema,
which
would
be
consistent
with
the
predominantly
venular
inflamma-
tion
that
occurs
in
Behcet's.5
Demyelination
per
se
does
not
alter
MRI
signal,
as
intact
myelin
makes
no
contribution
to
MRI
sig-
nal.6
It
is
the
replacement
of
myelin
with
extracellular
fluid
or
gliosis
which
shows
demyelinating
lesions
on
MRI.
In
our
case
the
massive
midbrain
lesion
produced
surprisingly
few
symptoms.
As
in
multiple
sclerosis,
lesions
may
occur
with
or
without
clinical
manifestations.'
Lesions
may
also
show
apparent
shrinkage
and
even
disappearance
on
M
RI,`8
and
dynamic
serial
GdDTPA
enhanced
MRI
studies
have
now
given
an
insight
into
the
mechanisms
of
this
process
in
MS.8
Further
MRI
studies
are
required
to
determine
the
significance
of
these
MRI
findings
in
Behcet's.
ALLAN
G
KERMODE,
Multiple
Sclerosis
NMR
Research
Group,
Institute
of
Neurology,
Queen
Square,
London
WCIN
3BG
References
I
Besana
C,
Comi
G,
del
Maschio
A,
et
al.
Electrophysiological
and
MRI
evaluation
of
neurological
involvement
in
Behcet's
disease.
J
Neurol
Neurosurg
Psychiatry
1989;52:
749-54.
2
Kermode
AG,
Plant
GT,
MacManus
DG,
et
al.
Behcet's
disease
with
slowly
enlarging
mid-
brain
mass
on
MRI:
resolution
following
steroid
therapy.
Neurology
1989;39:1251-2.
3
Barnes
D,
McDonald
WI,
Johnson
G,
et
al.
Quantitative
nuclear
magnetic
resonance
imaging;
characterisation
of
experimental
cerebral
oedema.
J
Neurol
Neurosurg
Psychiatry
1987;50:125-33.
4
Barnes
D,
McDonald
WI,
Landon
DN,
Johnson
G.
Characterisation
of
experimental
gliosis
by
quantitative
nuclear
magnetic
resonance
imaging.
Brain
1988;111:83-94.
5
Lehner
T,
Barnes
CG
(eds).
Recent
advances
in
the
other,
another
male
patient
had
under-
Behcet's
disease.
London,
Royal
Soc
Med
gone
11
different
therapies.
Services
Limited,
1986.
No
treatment
was
consistently
effective.
6
Ormerod
IEC,
Miller
DH,
McDonald
WI,
et
al.
Thirty
cent
of
those
who
had
received
The
role
of
NMR
imaging
in
the
assessment
medication
reported
improvement.
Eight
of
of
multiple
sclerosis
and
isolated
ted1catien
re
7re
who
had
of
neurological
lesions:
a
quantitative
study.
the
14
patients
(57%)
who
had
received
Brain
1987;110:1579-616.
surgery
derived
some
benefit
from
it.
The
7
Isaac
C,
Li
DKB,
Genton
M,
et
al.
Multiple
effects
of
relaxation-oriented
therapies
com-
sclerosis:
a
serial
study
using
MRI
in
pared
favourably
with
the
physical
therapies;
relapsing
patients.
Neurology
1988;38:
the
latter
were
considered
helpful
only
by
a
1511-15.
minority
of
the
patients.
Using
the
data
in
8
Kermode
AG,
Tofts
PS,
MacManus
DG,
et
al.
the
table
base
rate
for
comparison
with
Heterogeneity
of
blood-brain
barrier
efficacy
data
reported
for
botulinum
toxin
changes
multiple
sclerosis:
an
MRI
study.
injection,"
it
is
evident
that
this
most
recent
Neurology
(in
press).
therapy
for
torticollis
is
also
the
most
effective,
and
has
resulted
in
improvement
in
Treatments
for
torticollis
63-88%
of
treated
cases.
Sir:
Until
recently,
pharmacotherapy
con-
stituted
the
major
therapeutic
approach
to
the
management
of
torticollis,
with
surgery
reserved
as
an
intervention
in
a
small
number
of
cases.
A
variety
of
other
therapies
have
also
been
used
in
the
management
of
torti-
collis.
However,
no
or
little
information
about
the
effects
of
the
majority
of
these
alternative
techniques
has
been
available.
We
recently
obtained
information
about
the
types
and
the
effects
of
treatments
under-
taken
by
72
patients
with
adult-onset
idiopathic
torticollis
(Table).
The
treatments
can
be
grouped
into
the
two
main
categories
of
physical
and
relax-
ation-oriented
therapies.
Many
patients
had
undertaken
a
large
number
of
alternative
treatments
for
their
torticollis,
an
average
of
4-4
treatments.
At
the
two
extremes,
one
male
patient
had
had
no
treatment,
and
at
M
JAHANSHAHI,
CD
MARSDEN
Department
of
Clinical
Neurology,
Institute
of
Neurology,
Queen
Square,
London
WCJN
3BG
References
1
Brin
MF,
Fahn
S,
Moskowitz
C,
et
al.
Localized
injections
of
botulinum
toxin
for
the
treat-
ment
of
focal
dystonia
and
hemifacial
spasm.
Advances
in
Neurology
1988;50:599-608.
2
Stell
R,
Thompson
P,
Marsden
CD.
Botulinum
toxin
in
spasmodic
torticollis.
J
Neurol
Neurosurg
Psychiatry
1988;51:920-3.
3
Tsui
JK,
Eisen
A,
Mak
E,
Carruthers
J,
Scott
A,
Calne
DB.
A
pilot
study
on
the
use
of
botulinum
toxin
in
spasmodic
torticollis.
Can
J
Neurol
Sci
1985;12:314-6.
4
Tsui
JK,
Eisen
A,
Stoessl
AJ,
Calne
S,
Calne
DB.
Double
blind
study
of
botulinum
toxin
in
spasmodic
torticollis.
Lancet
1986;ii:
245-6.
Table
The
number
ofpatients
who
had
received
different
treatments
and
their
reports
of
the
effect
of
the
treatment.
Number
of
patients
Effects
of
treatment
who
had
undergone
Percentage
Treatment
treatment
Better
Unchanged
Worse
improved
Medication
69
21
48
30
Surgery
14
8
5
1
57
Physical
therapies:
Wearing
collar
51
4
33
12
8
Physiotherapy
39
6
24
7
16
Acupuncture
29
5
22
19
Osteopathy
29
3
22
2
11
Chiropractic
13
3
7
2
25
Relaxation
therapies:
Hypnosis
19
3
13
1
18
Behaviour
therapy
(relaxation
training,
massed
practice)
17
9
7
56
Biofeedback
7
1
6
14
Meditation
11
5
5
1
46
Other:
Homeopathy
15
1
12 8
Due
to
missing
data,
the
figures
in
the
"effects
of
treatment"
columns
do
not
always
add
up
to
the
total
number
of
patients
who
have
had
a
particular
treatment.
The
percentage
improvement
figures
are
therefore
based
on
the
number
of
patients
who
reported
the
effects
of
a
particular
treatment.
1212
group.bmj.com on July 11, 2011 - Published by jnnp.bmj.comDownloaded from

doi: 10.1136/jnnp.52.10.1212
1989 52: 1212J Neurol Neurosurg Psychiatry
A G Kermode
MRI in Behçet's disease.
http://jnnp.bmj.com/content/52/10/1212.1.citation
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