Aktuelle Rheumatologie 2019; 44(02): 109-114
DOI: 10.1055/s-0043-117883
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Neuro-Behcet: The Value of Transcranial Doppler

Neuro-Behcet: Der Wert des transkraniellen Dopplers
Samar H. Goma
1   Department of Physical Medicine, Rheumatology and Rehabilitation, Assiut University Hospitals, Assiut, Egypt
,
Zahraa I. Selim
1   Department of Physical Medicine, Rheumatology and Rehabilitation, Assiut University Hospitals, Assiut, Egypt
,
Ghaydaa A. Shehata
2   Department of Neuropsychiatry of the Upper Egypt, Assiut University Hospitals, Assiut, Egypt
,
Doaa Samir Sayed
3   Department of Dermatology and Venereology, Assiut University Hospitals, Assiut, Egypt
,
Dalia Ahmed
1   Department of Physical Medicine, Rheumatology and Rehabilitation, Assiut University Hospitals, Assiut, Egypt
› Author Affiliations
Further Information

Publication History

Publication Date:
11 September 2017 (online)

Abstract

Abstract Neurological involvement in Behcet disease (BD) is one of the most serious causes of long term morbidity and mortality and can be found in up to 49% of cases. There are 2 main types of CNS involvement, parenchymal and non-parenchymal. Transcranial Doppler (TCD) ultrasonography provides a relatively inexpensive, noninvasive, evaluation of the haemodynamics within intracranial arteries.

Material and Methods Case control study of 15 patients with NBD all of them fulfilled the criteria of the International Study Group for Behcet’s disease and fifteen apparently healthy volunteers age and sex matched. All patients and healthy controls were examined by TCD. Cranial Magnitic Resonance Imaging (MRI) examination was performed to the patients group.

Results Transcranial Doppler showed significant decline in the mean velocity (MV) of all the examined cerebral arteries in all NBD patients with the highest significant decrease in the vertebral artery (VA). On the other hand, a significant increase in the pulsatility index (PI) was detected only in the posterior cerebral artery (PCA). Regarding MRI examinations of our patients, 7 of 15 (46.7%) patients had parenchymal lesions, 13% had vascular lesions coexisting with parenchymal lesions (mixed). The parenchymal were located in the periventricular and superficial cerebral white matter, thalamus and brainstem followed by the cerebellum. Vascular lesions were dural and transverse sinus thrombosis.

Conclusion TCD provides a sensitive and accurate bed-side non-invasive imaging tool for the detection of flow pattern abnormalities in patients with NBD. MRI remains the gold standard for diagnosis.

Zusammenfassung

Hintergrund Die neurologische Beteiligung bei Morbus Behcet (BD) zählt zu den schwerwiegendsten Ursachen für langfristige Morbidität und Mortalität und betrifft bis zu 49% der BD-Patienten. Es werden 2 Hauptarten der ZNS-Beteiligung unterschieden: die parenchymale und die nicht-parenchymale. Die transkranielle Doppler-Ultrasonographie (TCD) ermöglicht eine relativ kostengünstige, nicht-invasive Beurteilung der Hämodynamik innerhalb der intrakraniellen Arterien.

Material und Methoden Es wurde eine Fallkontrollstudie mit 15 Patienten durchgeführt, die alle an Morbus Behcet mit neurologischer Beteiligung (NBD) litten und die Kriterien der internationalen Studiengruppe für M. Behcet erfüllten. Zudem nahmen 15 gesunde Probanden mit entsprechender Alters- und Geschlechtsverteilung an der Studie teil. Alle Patienten und die gesunden Probanden wurden mittels TCD untersucht. Die Patientengruppe wurde zusätzlich einer kraniellen Magnetresonanztomographie (MRT) unterzogen.

Ergebnisse Die transkranielle Doppler-Sonographie zeigte bei allen NBD-Patienten in allen untersuchten Arterien eine signifikante Abnahme der mittleren Strömungsgeschwindigkeit (MV, „mean velocity“). Die höchste signifikante Abnahme fand sich in der A. vertebralis (VA). Eine signifikante Zunahme des Pulsatilitätsindexes (PI) wurde demgegenüber nur in der A. cerebralis posterior (PCA) festgestellt. Die MRT-Untersuchungen unserer Patienten ergaben bei 7 von 15 Patienten (46,7%) parenchymale Läsionen. Bei 13% der Patienten wurden koexistierende vaskuläre und parenchymale Läsionen (gemischt) festgestellt. Die parenchymalen Läsionen fanden sich in der periventrikulären und der oberflächlichen zerebralen weißen Substanz, im Thalamus, Hirnstamm und Kleinhirn. Bei den vaskulären Läsionen handelte es sich um Thrombosen der Sinus durae matris und des Sinus transversus.

Schlussfolgerung Die TCD ist ein sensibles und präzises, nicht-invasives, direkt am Patientenbett durchführbares Bildgebungsverfahren zur Feststellung von Anomalien im Strömungsmuster bei Patienten mit NBD. Goldstandard in der Diagnostik ist nach wie vor die MRT.

 
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