Pseudotumoral Behçet's Disease | Reumatología Clínica

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Dos meses después con resolución completa de la lesión (b). Caso 2: RMN axial FLAIR mostrando una lesión hiperintensa en la sustancia blanca izquierda del área frontoparietal extendiéndose hasta córtex y cuerpo calloso con realce tras gadolinio (c). Después de veinte días de corticoterapia una nueva RMN mostró una importante reducción del componente hiperintenso (d). Hallazgos histopatológicos de la biopsia cerebral que muestran un infiltrado linfocítico perivascular con afectación de los vasos sanguíneos (hematoxilina-eosina) (e). Infiltrado inflamatorio granulomatoso (hematoxilina-eosina), (f). 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] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Brief Report" "titulo" => "Pseudotumoral Behçet's Disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "85" "paginaFinal" => "90" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sara Alonso, Anne Riveros-Frutos, Melania Martínez-Morillo, Laia Grau-Ferrer, Cristina Carrato, Alejandro Olivé" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Sara" "apellidos" => "Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Anne" "apellidos" => "Riveros-Frutos" "email" => array:1 [ 0 => "anne.riveros@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Melania" "apellidos" => "Martínez-Morillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Laia" "apellidos" => "Grau-Ferrer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Cristina" "apellidos" => "Carrato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "Alejandro" "apellidos" => "Olivé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Sección de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Anatomía patológica, Hospital Universitario Germans Trias i Pujol, Badalona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad de Behçet pseudotumoral" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1a–h" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2080 "Ancho" => 1300 "Tamanyo" => 382199 ] ] "descripcion" => array:1 [ "en" => "Case no. 1: Axial fluid-attenuated inversion recovery (FLAIR) magnetic resonance image (MRI) shows a hyperintense lesion in left thalamus (a). In an image acquired 2 months later, complete resolution of the lesion is observed (b). Case no. 2: Axial FLAIR MRI shows a hyperintense lesion in white matter of the left frontoparietal region, extending to the cortex and corpus callosum, in a gadolinium-enhanced image (c). MRI performed after 20 days of corticosteroid therapy shows a significant reduction in the hyperintense area (d). Histopathological findings in brain biopsy show a perivascular lymphocytic infiltrate with blood vessel involvement (hematoxylin-eosin) (e). Granulomatous inflammatory infiltrate (hematoxylin-eosin) (f). Brain 11C-methionine positron emission tomography (PET) images showing parasagittal deposition of 11C-methionine suggestive of possible lymphoma (g and h)." ] ] ] "textoCompleto" => "IntroductionBehçet's disease (BD) is a recurrent systemic vasculitis that is diagnosed on the basis of clinical criteria.<a class="elsevierStyleCrossRef" href="#bib0165">1</a> Neurological involvement, although uncommon, is among the causes of higher morbidity and mortality rates, and is included in the differential diagnosis of inflammatory and demyelinating diseases of the central nervous system.<a class="elsevierStyleCrossRef" href="#bib0170">2</a> The prevalence of neuro-BD (NBD) ranges between 1% and 59%, according to different series,<a class="elsevierStyleCrossRefs" href="#bib0165">1–5</a> and it is more common among men. Neurological involvement frequently develops 5 years after the diagnosis of BD,<a class="elsevierStyleCrossRef" href="#bib0170">2</a> but may be a form of onset, which masks the diagnosis because of its atypical presentation.<a class="elsevierStyleCrossRefs" href="#bib0165">1,3</a> Parenchymal or extraparenchymal involvement can be observed and, in rare cases, it has been reported to present in the form of a pseudotumor.<a class="elsevierStyleCrossRefs" href="#bib0170">2,4,6–14</a>We present the cases of 2 patients who were diagnosed with NBD when pseudotumors of the brain were detected.Case reportsCase no. 1The patient was a 63-year-old man who presented with a 1-month history of behavioral changes in the form of irritability, aggressiveness and emotional lability, as well as difficulty in walking and agraphia. He mentioned a 35-year history of recurrent oral ulcers, and that sores had appeared on his genitals over the preceding 6 months, accompanied by folliculitis in the genital region and lower extremities. In the physical examination, he was found to have temporospatial disorientation; bradypsychia; right facial, brachial and femoral paresis (4/5); and tendency to list or veer toward the right when walking; together with oral and genital ulcers. The most noteworthy laboratory findings were elevated acute phase reactant levels, negative results in serological tests for Brucella, syphilis, hepatitis B virus, hepatitis C virus and human immunodeficiency virus, and negative findings in an autoimmunity study. He tested positive for HLA B51. Brain magnetic resonance imaging (MRI) revealed the presence of a space-occupying lesion in left thalamus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1.1</a>). An angiographic study of the supra-aortic trunks revealed small-vessel disease and atheromatous lesions in the carotid bifurcations, as well as saccular aneurysms and infundibula, with images of vascular nidi in the left carotid territory suggestive of vasculitis. Thoracoabdominal computed tomography was normal. Lumbar puncture yielded clear cerebrospinal fluid, with an unremarkable protein content, without oligoclonal bands. As NBD was suspected, treatment was initiated with methylprednisolone pulse therapy, followed by oral prednisone (1mg/kg body weight [bw]/day), colchicine (1mg/12h) and oral azathioprine (2mg/kg bw/day). The patient's clinical status improved, his genital ulcers disappeared and there was no evidence of the neurological manifestations. After 3 months of treatment, he underwent follow-up brain MRI which revealed the complete resolution of the lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig.1.2</a>). After 15 years of follow-up, the patient has no clinical neurological symptoms and is receiving absolutely no treatment. However, he has had sporadic oral aphthae, which have responded well to colchicine.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Case no. 2The second patient was a 35-year-old woman who had generalized seizures and a 2-month history of paresthesia in the right malar region. The results of the physical examination were normal. Laboratory analyses showed elevated acute phase reactant levels, negative results in serological tests for human immunodeficiency virus, hepatitis B virus and hepatitis C virus, and a negative autoimmunity study. Brain MRI revealed the presence of an intraparenchymal infiltrative lesion affecting left frontoparietal region, with enhanced images following gadolinium administration (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1.3</a>), which was diagnosed as a brain tumor. Lumbar puncture yielded clear, acellular fluid with slightly elevated protein content and no oligoclonal bands. Treatment was begun with intravenous dexamethasone (12mg/day), which was subsequently tapered. Twenty days later, brain MRI showed a significant reduction in the size of the lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1.4</a>). 11C-methionine positron emission tomography (PET) of the brain suggested the presence of cerebral lymphoma (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1.7 and 1.8</a>). The brain mass was biopsied, and the histological study revealed the presence of a focal necrotizing granulomatous infiltrate with lymphocytic vasculitis (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1.5 and 1.6</a>). Ziehl-Neelsen, periodic acid Schiff (PAS) and silver stains were negative. The results of thoracoabdominal computed tomography, 67gallium scintigraphy and a transbronchial biopsy ruled out sarcoidosis. Three months later, the patient developed oral and genital ulcers. She tested positive for HLA B51. With findings indicative of NBD, treatment was begun with monthly cyclophosphamide pulses (1g/month) plus tapering glucocorticoid doses. After 5 months with this treatment, she had another seizure, and brain MRI performed at that time showed that the lesion had increased in size. As cyclophosphamide was considered to be ineffective, it was replaced by oral azathioprine (2mg/kg bw/day) and the prednisone dose was increased to 30mg/day, after which it was tapered. Four months later, there was no evidence of improvement in the lesion on brain MRI, and the decision was made to start treatment with intravenous infliximab (3mg/kg bw every 8 weeks). After 8 doses of infliximab, there was a significant reduction in the size of the mass, but the patient developed diffuse joint pain and refused to continue the treatment. It was replaced by adalimumab, which she tolerated well. At the time of this writing, 5 years later, she continues to receive subcutaneous adalimumab (40mg/15 days) as single-drug therapy. Her tolerance is well and the brain lesion has not progressed. Over the course of the disease, she has had episodes of oral ulcers that responded to symptomatic treatment.DiscussionThe clinical presentation and course of NBD complicate the diagnosis of this condition.<a class="elsevierStyleCrossRef" href="#bib0185">5</a> It can present either in the acute form, which responds well to treatment with glucocorticoids and immunosuppressive agents, or in the progressive or chronic form (in which high interleukin 6 [IL-6] concentrations have been reported in cerebrospinal fluid), which is normally resistant to glucocorticoid, cyclophosphamide and azathioprine therapy. These patients have been found to have a better response to methotrexate and/or infliximab.<a class="elsevierStyleCrossRefs" href="#bib0235">15–17</a> The presence of lesions compatible with pseudotumors on brain MRI is very rare in NBD, especially as the form of onset of the disease.<a class="elsevierStyleCrossRefs" href="#bib0170">2,4</a> The neurological manifestations of BD usually appear from 2 to 4 years after the first clinical sign. However, cases of NBD in which the neurological manifestations preceded other signs of the disease have been reported in the scientific literature.<a class="elsevierStyleCrossRefs" href="#bib0250">18,19</a> For this reason, when there is a single brain lesion in the absence of other signs, such as oral and genital ulcers, the diagnosis of BD proves to be complicated.The differential diagnosis of NBD includes multiple sclerosis, infections, vascular disease and tumors. While both computed tomography and MRI of the brain are sensitive imaging techniques for the diagnosis of lesions, the sensitivity of the latter is greater.<a class="elsevierStyleCrossRef" href="#bib0255">19</a> In brain MRI, the finding is described as a hyperintense signal on T2-weighted images, located predominantly at the diencephalic mesencephalic junction and in the basal ganglia,<a class="elsevierStyleCrossRefs" href="#bib0175">3,20–22</a> although the lesion is sometimes found in the periventricular white matter. This makes it difficult to differentiate between NBD and multiple sclerosis. However, multiple locations are reported in the scientific literature (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), and its presentation has even been described as a hypointense mass on T2-weighted images.<a class="elsevierStyleCrossRef" href="#bib0190">6</a> To differentiate it from a tumor in the definitive diagnosis, it is sometimes necessary to perform a brain biopsy, as in the second case reported here.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The histological study of biopsies of brain pseudotumors in NBD reveals a perivascular inflammatory infiltrate, gliosis, necrosis or neuronal loss.<a class="elsevierStyleCrossRefs" href="#bib0195">7,8,11,23</a>Treatment with glucocorticoids, as well as the use of other immunosuppressive agents (cyclophosphamide or azathioprine), is accompanied by a rapid response, with a reduction in size or even the disappearance of the lesion.To date, 27 cases of pseudotumors developing in the course of NBD have been reported in the scientific literature (PubMed: 1987–2014; search terms: neuro-Behçet, pseudotumoral). The Table shows the clinical characteristics of these lesions. The reported cases suggest that pseudotumors develop more often in men (n=18, 66.7%) than in women, with a mean age at presentation of 38 years (range, 16–59 years); the most common site was the thalamus and basal ganglia. All the patients described were initially treated with high-dose oral or intravenous glucocorticoids. Other immunosuppressive agents, such as azathioprine, cyclophosphamide, methotrexate and chlorambucil, were added.The patient in our first case responded rapidly to treatment with glucocorticoids and azathioprine, whereas the second patient required biological therapy with anti-tumor necrosis factor-α and infliximab at first and, subsequently, adalimumab. This is one of the few cases of the use of biological therapy for the management of these patients reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0280">24,25</a>A pseudotumor in NBD should be considered in the differential diagnosis of brain masses, especially when a good clinical response is achieved after treatment with glucocorticoids. Biopsy may sometimes be necessary to confirm the diagnosis.Ethical DisclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflicts of InterestThe authors declare they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres626724" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec639877" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres626725" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec639876" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Case reports" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Case no. 1" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Case no. 2" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of Interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-01-07" "fechaAceptado" => "2015-03-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec639877" "palabras" => array:3 [ 0 => "Behçets disease" 1 => "Neuro-Behçets disease" 2 => "Pseudotumotal brain lesions" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec639876" "palabras" => array:3 [ 0 => "Enfermedad de Behçet" 1 => "Neuro-Behçet" 2 => "Lesiones cerebrales pseudotumorales" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Behçet's disease is a systemic vasculitis characterized by the presence of oral and genital ulcers. Neurological involvement or neuro-Behçet is an uncommon manifestation. It manifestation has predominance in the male gender appearing 2–4 years after the first clinical manifestation.However, neuro-Behçet disease sometimes occurs with pseudotumoral brain lesions. Herein, we present the cases of two patients diagnosed with neuro-Behçet after detection of pseudotumoral brain lesions. A review of the literature is performed." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La enfermedad de Behçet es una vasculitis caracterizada por úlceras bucales y genitales. La afectación neurológica o neuro-Behçet es una manifestación infrecuente, de predominio en el género masculino y que aparece de 2 a 4 años después de la primera manifestación clínica.El neuro-Behçet cursa ocasionalmente lesiones cerebrales pseudotumorales. Presentamos 2 casos de pacientes diagnosticados de neuro-Behçet tras la detección de lesiones cerebrales pseudotumorales y se realiza una revisión de la literatura." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Alonso S, Riveros-Frutos A, Martínez-Morillo M, Grau-Ferrer L, Carrato C, Olivé A. Enfermedad de Behçet pseudotumoral. Reumatol Clin. 2016;12:85–90." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1a–h" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2080 "Ancho" => 1300 "Tamanyo" => 382199 ] ] "descripcion" => array:1 [ "en" => "Case no. 1: Axial fluid-attenuated inversion recovery (FLAIR) magnetic resonance image (MRI) shows a hyperintense lesion in left thalamus (a). In an image acquired 2 months later, complete resolution of the lesion is observed (b). Case no. 2: Axial FLAIR MRI shows a hyperintense lesion in white matter of the left frontoparietal region, extending to the cortex and corpus callosum, in a gadolinium-enhanced image (c). MRI performed after 20 days of corticosteroid therapy shows a significant reduction in the hyperintense area (d). Histopathological findings in brain biopsy show a perivascular lymphocytic infiltrate with blood vessel involvement (hematoxylin-eosin) (e). Granulomatous inflammatory infiltrate (hematoxylin-eosin) (f). Brain 11C-methionine positron emission tomography (PET) images showing parasagittal deposition of 11C-methionine suggestive of possible lymphoma (g and h)." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "–: unknown; F: female; IV: intravenous; M: male." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age (years) Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">History of Behçet's disease (years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lesion site \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lumbar puncture \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pathological findings \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Litvan<a class="elsevierStyleCrossRef" href="#bib0230">14</a> 1987 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left parieto-occipital region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increased proteins in cerebrospinal fluid with negative cultures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Partial improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Neudorfer<a class="elsevierStyleCrossRef" href="#bib0230">14</a> 1993 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No history prior to diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right lentiform nucleus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Geny<a class="elsevierStyleCrossRef" href="#bib0290">26</a> 1993 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thalamocapsular region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nonspecific. No evidence of tumor. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dupin<a class="elsevierStyleCrossRef" href="#bib0230">14</a> 1996 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No history prior to diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cerebellum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids, colchicine, azathioprine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Visaga<a class="elsevierStyleCrossRef" href="#bib0295">27</a> 1996 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">From bulbomedullary junction to cerebral peduncle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids, chlorambucil \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yoshimura<a class="elsevierStyleCrossRef" href="#bib0300">28</a> 2001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Several \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left thalamolenticular region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pleocytosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nonspecific. No evidence of tumor. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ben Taarit<a class="elsevierStyleCrossRef" href="#bib0315">31</a> 2002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Protuberance and right cerebral peduncle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Imoto<a class="elsevierStyleCrossRef" href="#bib0200">8</a> 2002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No history prior to diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Basal ganglia, brainstem and white matter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inflammatory cells and perivascular infiltrate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reduced size \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 glucocorticoid boluses \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Park<a class="elsevierStyleCrossRef" href="#bib0215">11</a> 2002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No history prior to diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right cerebellar hemisphere extending to 3rd ventricle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lymphocytes 25/μL, proteins 300mg/dL, glucose normal. No oligoclonal bands. Anti-CMV and herpes simplex negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lymphocytic vasculitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Initial disappearance. Three episodes of recurrence. Death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids, azathioprine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Tuzgen<a class="elsevierStyleCrossRef" href="#bib0190">6</a> 2003</td><td class="td" title="table-entry " align="left" valign="top">59 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No history prior to diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right frontotemporal region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gliosis, panvasculitis, thrombosis, extensive infarction and vascular proliferation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Radiological improvement. Persistent left hemiparesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Surgical excision \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">45 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left diencephalic-mesencephalic junction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Bennett<a class="elsevierStyleCrossRef" href="#bib0195">7</a> 2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left temporal lobe, invading peduncle, thalamus, internal capsule, basal ganglia and posterior corona radiata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Perivascular inflammatory infiltrate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical and radiological improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids, azathioprine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Matsuo<a class="elsevierStyleCrossRef" href="#bib0220">12</a> 2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Basal ganglia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pleocytosis 26mm3 (mononuclear), normal glucose and protein levels. No oligoclonal bands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reactive gliosis with inflammatory infiltrate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 glucocorticoid boluses \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Schmolck<a class="elsevierStyleCrossRef" href="#bib0310">30</a> 2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left thalamus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Radiological improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dexamethasone, monthly cyclophosphamide boluses \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Darmoul<a class="elsevierStyleCrossRef" href="#bib0210">10</a> 2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left thalamus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Radiological improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids, immunosuppressive agents \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Appenzeller<a class="elsevierStyleCrossRef" href="#bib0180">4</a> 2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right thalamus, lentiform nucleus, subthalamic area and peduncle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gliosis with gemistocytic astrocyte \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disappearance of the mass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dexamethasone 4mg/day IV, methylprednisolone 1g/3 days IV, oral prednisone 60mg/day, cyclophosphamide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Kösters<a class="elsevierStyleCrossRef" href="#bib0225">13</a> 2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No history prior to diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Frontoparietal region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal cell counts, glucose levels and protein levels. No malignant cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lymphocytic vasculitis of small vessels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dexamethasone, azathioprine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Heo<a class="elsevierStyleCrossRef" href="#bib0205">9</a> 2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multiple masses in left pons region and left parietal cortex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Perivascular lymphocytic infiltrate, focal necrosis, gliosis, foamy histiocytes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reduced mass size \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">High-dose glucocorticoids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Varoglu<a class="elsevierStyleCrossRef" href="#bib0305">29</a> 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mesencephalon, bilateral basal ganglia, posterior limb of internal capsule and centrum semiovale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nontumoral lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reduced lesion size \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Bouomrani<a class="elsevierStyleCrossRef" href="#bib0320">32</a> 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Brainstem \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cyclosporine, prednisone, cyclophosphamide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">Noel<a class="elsevierStyleCrossRef" href="#bib0230">14</a> 2012</td><td class="td" title="table-entry " align="left" valign="top">57 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lenticulocapsular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aseptic meningitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Methylprednisolone, cyclophosphamide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">47 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Peduncles, basal ganglia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids, azathioprine, cyclophosphamide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">48 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lenticulocapsular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aseptic meningitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Methylprednisolone, cyclophosphamide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">34 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No history prior to diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thalamocapsular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Necrosis with inflammatory infiltrate, and infiltration by neutrophils, lymphocytes and macrophages compatible with vasculitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Methylprednisolone, cyclophosphamide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">30 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lenticulocapsular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aseptic meningitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prednisone, cyclophosphamide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Shapiro<a class="elsevierStyleCrossRef" href="#bib0285">25</a> 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cerebral peduncle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pleocytosis with negative cultures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids, infliximab and subsequent tocilizumab with good response \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Martínez-Estupiñan<a class="elsevierStyleCrossRef" href="#bib0280">24</a> 2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cerebellum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aseptic meningitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reactive changes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Poor response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucocorticoids, azathioprine, adalimumab; subsequent tocilizumab, cyclophosphamide, rituximab and plasmapheresis \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1028266.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical Characteristics of the Cases Reported in the Literature." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0165" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical patterns of neurological involvement in Behçet's disease: evaluation of 200 patients. 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Brief Report

Pseudotumoral Behçet's Disease

Enfermedad de Behçet pseudotumoral

Sara Alonsoa, Anne Riveros-Frutosb,

Corresponding author

anne.riveros@gmail.com

Corresponding author.

, Melania Martínez-Morillob, Laia Grau-Ferrerc, Cristina Carratod, Alejandro Olivéb

a Sección de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Spain

b Servicio de Reumatología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain

c Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain

d Servicio de Anatomía patológica, Hospital Universitario Germans Trias i Pujol, Badalona, Spain

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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Case no&#46; 1&#58; Axial fluid-attenuated inversion recovery &#40;FLAIR&#41; magnetic resonance image &#40;MRI&#41; shows a hyperintense lesion in left thalamus &#40;a&#41;&#46; In an image acquired 2 months later&#44; complete resolution of the lesion is observed &#40;b&#41;&#46; Case no&#46; 2&#58; Axial FLAIR MRI shows a hyperintense lesion in white matter of the left frontoparietal region&#44; extending to the cortex and corpus callosum&#44; in a gadolinium-enhanced image &#40;c&#41;&#46; MRI performed after 20 days of corticosteroid therapy shows a significant reduction in the hyperintense area &#40;d&#41;&#46; Histopathological findings in brain biopsy show a perivascular lymphocytic infiltrate with blood vessel involvement &#40;hematoxylin-eosin&#41; &#40;e&#41;&#46; Granulomatous inflammatory infiltrate &#40;hematoxylin-eosin&#41; &#40;f&#41;&#46; Brain <span class="elsevierStyleSup">11</span>C-methionine positron emission tomography &#40;PET&#41; images showing parasagittal deposition of <span class="elsevierStyleSup">11</span>C-methionine suggestive of possible lymphoma &#40;g and h&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Beh&#231;et&#39;s disease &#40;BD&#41; is a recurrent systemic vasculitis that is diagnosed on the basis of clinical criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> Neurological involvement&#44; although uncommon&#44; is among the causes of higher morbidity and mortality rates&#44; and is included in the differential diagnosis of inflammatory and demyelinating diseases of the central nervous system&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> The prevalence of neuro-BD &#40;NBD&#41; ranges between 1&#37; and 59&#37;&#44; according to different series&#44;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#8211;5</span></a> and it is more common among men&#46; Neurological involvement frequently develops 5 years after the diagnosis of BD&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> but may be a form of onset&#44; which masks the diagnosis because of its atypical presentation&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1&#44;3</span></a> Parenchymal or extraparenchymal involvement can be observed and&#44; in rare cases&#44; it has been reported to present in the form of a pseudotumor&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">2&#44;4&#44;6&#8211;14</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the cases of 2 patients who were diagnosed with NBD when pseudotumors of the brain were detected&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case reports</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case no&#46; 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 63-year-old man who presented with a 1-month history of behavioral changes in the form of irritability&#44; aggressiveness and emotional lability&#44; as well as difficulty in walking and agraphia&#46; He mentioned a 35-year history of recurrent oral ulcers&#44; and that sores had appeared on his genitals over the preceding 6 months&#44; accompanied by folliculitis in the genital region and lower extremities&#46; In the physical examination&#44; he was found to have temporospatial disorientation&#59; bradypsychia&#59; right facial&#44; brachial and femoral paresis &#40;4&#47;5&#41;&#59; and tendency to list or veer toward the right when walking&#59; together with oral and genital ulcers&#46; The most noteworthy laboratory findings were elevated acute phase reactant levels&#44; negative results in serological tests for <span class="elsevierStyleItalic">Brucella</span>&#44; syphilis&#44; hepatitis B virus&#44; hepatitis C virus and human immunodeficiency virus&#44; and negative findings in an autoimmunity study&#46; He tested positive for HLA B51&#46; Brain magnetic resonance imaging &#40;MRI&#41; revealed the presence of a space-occupying lesion in left thalamus &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1&#46;1</a>&#41;&#46; An angiographic study of the supra-aortic trunks revealed small-vessel disease and atheromatous lesions in the carotid bifurcations&#44; as well as saccular aneurysms and infundibula&#44; with images of vascular nidi in the left carotid territory suggestive of vasculitis&#46; Thoracoabdominal computed tomography was normal&#46; Lumbar puncture yielded clear cerebrospinal fluid&#44; with an unremarkable protein content&#44; without oligoclonal bands&#46; As NBD was suspected&#44; treatment was initiated with methylprednisolone pulse therapy&#44; followed by oral prednisone &#40;1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg body weight &#91;bw&#93;&#47;day&#41;&#44; colchicine &#40;1<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#41; and oral azathioprine &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg bw&#47;day&#41;&#46; The patient&#39;s clinical status improved&#44; his genital ulcers disappeared and there was no evidence of the neurological manifestations&#46; After 3 months of treatment&#44; he underwent follow-up brain MRI which revealed the complete resolution of the lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46;1&#46;2</a>&#41;&#46; After 15 years of follow-up&#44; the patient has no clinical neurological symptoms and is receiving absolutely no treatment&#46; However&#44; he has had sporadic oral aphthae&#44; which have responded well to colchicine&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case no&#46; 2</span><p id="par0020" class="elsevierStylePara elsevierViewall">The second patient was a 35-year-old woman who had generalized seizures and a 2-month history of paresthesia in the right malar region&#46; The results of the physical examination were normal&#46; Laboratory analyses showed elevated acute phase reactant levels&#44; negative results in serological tests for human immunodeficiency virus&#44; hepatitis B virus and hepatitis C virus&#44; and a negative autoimmunity study&#46; Brain MRI revealed the presence of an intraparenchymal infiltrative lesion affecting left frontoparietal region&#44; with enhanced images following gadolinium administration &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1&#46;3</a>&#41;&#44; which was diagnosed as a brain tumor&#46; Lumbar puncture yielded clear&#44; acellular fluid with slightly elevated protein content and no oligoclonal bands&#46; Treatment was begun with intravenous dexamethasone &#40;12<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; which was subsequently tapered&#46; Twenty days later&#44; brain MRI showed a significant reduction in the size of the lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1&#46;4</a>&#41;&#46; <span class="elsevierStyleSup">11</span>C-methionine positron emission tomography &#40;PET&#41; of the brain suggested the presence of cerebral lymphoma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figs&#46; 1&#46;7 and 1&#46;8</a>&#41;&#46; The brain mass was biopsied&#44; and the histological study revealed the presence of a focal necrotizing granulomatous infiltrate with lymphocytic vasculitis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figs&#46; 1&#46;5 and 1&#46;6</a>&#41;&#46; Ziehl-Neelsen&#44; periodic acid Schiff &#40;PAS&#41; and silver stains were negative&#46; The results of thoracoabdominal computed tomography&#44; <span class="elsevierStyleSup">67</span>gallium scintigraphy and a transbronchial biopsy ruled out sarcoidosis&#46; Three months later&#44; the patient developed oral and genital ulcers&#46; She tested positive for HLA B51&#46; With findings indicative of NBD&#44; treatment was begun with monthly cyclophosphamide pulses &#40;1<span class="elsevierStyleHsp" style=""></span>g&#47;month&#41; plus tapering glucocorticoid doses&#46; After 5 months with this treatment&#44; she had another seizure&#44; and brain MRI performed at that time showed that the lesion had increased in size&#46; As cyclophosphamide was considered to be ineffective&#44; it was replaced by oral azathioprine &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg bw&#47;day&#41; and the prednisone dose was increased to 30<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; after which it was tapered&#46; Four months later&#44; there was no evidence of improvement in the lesion on brain MRI&#44; and the decision was made to start treatment with intravenous infliximab &#40;3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg bw every 8 weeks&#41;&#46; After 8 doses of infliximab&#44; there was a significant reduction in the size of the mass&#44; but the patient developed diffuse joint pain and refused to continue the treatment&#46; It was replaced by adalimumab&#44; which she tolerated well&#46; At the time of this writing&#44; 5 years later&#44; she continues to receive subcutaneous adalimumab &#40;40<span class="elsevierStyleHsp" style=""></span>mg&#47;15 days&#41; as single-drug therapy&#46; Her tolerance is well and the brain lesion has not progressed&#46; Over the course of the disease&#44; she has had episodes of oral ulcers that responded to symptomatic treatment&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical presentation and course of NBD complicate the diagnosis of this condition&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> It can present either in the acute form&#44; which responds well to treatment with glucocorticoids and immunosuppressive agents&#44; or in the progressive or chronic form &#40;in which high interleukin 6 &#91;IL-6&#93; concentrations have been reported in cerebrospinal fluid&#41;&#44; which is normally resistant to glucocorticoid&#44; cyclophosphamide and azathioprine therapy&#46; These patients have been found to have a better response to methotrexate and&#47;or infliximab&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">15&#8211;17</span></a> The presence of lesions compatible with pseudotumors on brain MRI is very rare in NBD&#44; especially as the form of onset of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">2&#44;4</span></a> The neurological manifestations of BD usually appear from 2 to 4 years after the first clinical sign&#46; However&#44; cases of NBD in which the neurological manifestations preceded other signs of the disease have been reported in the scientific literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">18&#44;19</span></a> For this reason&#44; when there is a single brain lesion in the absence of other signs&#44; such as oral and genital ulcers&#44; the diagnosis of BD proves to be complicated&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The differential diagnosis of NBD includes multiple sclerosis&#44; infections&#44; vascular disease and tumors&#46; While both computed tomography and MRI of the brain are sensitive imaging techniques for the diagnosis of lesions&#44; the sensitivity of the latter is greater&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> In brain MRI&#44; the finding is described as a hyperintense signal on T2-weighted images&#44; located predominantly at the diencephalic mesencephalic junction and in the basal ganglia&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">3&#44;20&#8211;22</span></a> although the lesion is sometimes found in the periventricular white matter&#46; This makes it difficult to differentiate between NBD and multiple sclerosis&#46; However&#44; multiple locations are reported in the scientific literature &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; and its presentation has even been described as a hypointense mass on T2-weighted images&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">6</span></a> To differentiate it from a tumor in the definitive diagnosis&#44; it is sometimes necessary to perform a brain biopsy&#44; as in the second case reported here&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The histological study of biopsies of brain pseudotumors in NBD reveals a perivascular inflammatory infiltrate&#44; gliosis&#44; necrosis or neuronal loss&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7&#44;8&#44;11&#44;23</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Treatment with glucocorticoids&#44; as well as the use of other immunosuppressive agents &#40;cyclophosphamide or azathioprine&#41;&#44; is accompanied by a rapid response&#44; with a reduction in size or even the disappearance of the lesion&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">To date&#44; 27 cases of pseudotumors developing in the course of NBD have been reported in the scientific literature &#40;PubMed&#58; 1987&#8211;2014&#59; search terms&#58; neuro-Beh&#231;et&#44; pseudotumoral&#41;&#46; The Table shows the clinical characteristics of these lesions&#46; The reported cases suggest that pseudotumors develop more often in men &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#44; 66&#46;7&#37;&#41; than in women&#44; with a mean age at presentation of 38 years &#40;range&#44; 16&#8211;59 years&#41;&#59; the most common site was the thalamus and basal ganglia&#46; All the patients described were initially treated with high-dose oral or intravenous glucocorticoids&#46; Other immunosuppressive agents&#44; such as azathioprine&#44; cyclophosphamide&#44; methotrexate and chlorambucil&#44; were added&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patient in our first case responded rapidly to treatment with glucocorticoids and azathioprine&#44; whereas the second patient required biological therapy with anti-tumor necrosis factor-&#945; and infliximab at first and&#44; subsequently&#44; adalimumab&#46; This is one of the few cases of the use of biological therapy for the management of these patients reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">A pseudotumor in NBD should be considered in the differential diagnosis of brain masses&#44; especially when a good clinical response is achieved after treatment with glucocorticoids&#46; Biopsy may sometimes be necessary to confirm the diagnosis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Ethical Disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Protection of human and animal subjects</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Confidentiality of data</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Right to privacy and informed consent</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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            0 => "Beh&#231;ets disease"
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            0 => "Enfermedad de Beh&#231;et"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Beh&#231;et&#39;s disease is a systemic vasculitis characterized by the presence of oral and genital ulcers&#46; Neurological involvement or neuro-Beh&#231;et is an uncommon manifestation&#46; It manifestation has predominance in the male gender appearing 2&#8211;4 years after the first clinical manifestation&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">However&#44; neuro-Beh&#231;et disease sometimes occurs with pseudotumoral brain lesions&#46; Herein&#44; we present the cases of two patients diagnosed with neuro-Beh&#231;et after detection of pseudotumoral brain lesions&#46; A review of the literature is performed&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La enfermedad de Beh&#231;et es una vasculitis caracterizada por &#250;lceras bucales y genitales&#46; La afectaci&#243;n neurol&#243;gica o neuro-Beh&#231;et es una manifestaci&#243;n infrecuente&#44; de predominio en el g&#233;nero masculino y que aparece de 2 a 4 a&#241;os despu&#233;s de la primera manifestaci&#243;n cl&#237;nica&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El neuro-Beh&#231;et cursa ocasionalmente lesiones cerebrales pseudotumorales&#46; Presentamos 2 casos de pacientes diagnosticados de neuro-Beh&#231;et tras la detecci&#243;n de lesiones cerebrales pseudotumorales y se realiza una revisi&#243;n de la literatura&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Alonso S&#44; Riveros-Frutos A&#44; Mart&#237;nez-Morillo M&#44; Grau-Ferrer L&#44; Carrato C&#44; Oliv&#233; A&#46; Enfermedad de Beh&#231;et pseudotumoral&#46; Reumatol Clin&#46; 2016&#59;12&#58;85&#8211;90&#46;</p>"
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        "etiqueta" => "Fig&#46; 1a&#8211;h"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2080
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            "Tamanyo" => 382199
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Case no&#46; 1&#58; Axial fluid-attenuated inversion recovery &#40;FLAIR&#41; magnetic resonance image &#40;MRI&#41; shows a hyperintense lesion in left thalamus &#40;a&#41;&#46; In an image acquired 2 months later&#44; complete resolution of the lesion is observed &#40;b&#41;&#46; Case no&#46; 2&#58; Axial FLAIR MRI shows a hyperintense lesion in white matter of the left frontoparietal region&#44; extending to the cortex and corpus callosum&#44; in a gadolinium-enhanced image &#40;c&#41;&#46; MRI performed after 20 days of corticosteroid therapy shows a significant reduction in the hyperintense area &#40;d&#41;&#46; Histopathological findings in brain biopsy show a perivascular lymphocytic infiltrate with blood vessel involvement &#40;hematoxylin-eosin&#41; &#40;e&#41;&#46; Granulomatous inflammatory infiltrate &#40;hematoxylin-eosin&#41; &#40;f&#41;&#46; Brain <span class="elsevierStyleSup">11</span>C-methionine positron emission tomography &#40;PET&#41; images showing parasagittal deposition of <span class="elsevierStyleSup">11</span>C-methionine suggestive of possible lymphoma &#40;g and h&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">&#8211;&#58; unknown&#59; F&#58; female&#59; IV&#58; intravenous&#59; M&#58; male&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age &#40;years&#41;<br>Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">History of Beh&#231;et&#39;s disease &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lesion site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lumbar puncture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pathological findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Litvan<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> 1987&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left parieto-occipital region&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increased proteins in cerebrospinal fluid with negative cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Neudorfer<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> 1993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No history prior to diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Right lentiform nucleus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Geny<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a> 1993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Thalamocapsular region&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonspecific&#46;<br>No evidence of tumor&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Dupin<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> 1996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No history prior to diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cerebellum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&#44; colchicine&#44; azathioprine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Visaga<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> 1996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16<br>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">From bulbomedullary junction to cerebral peduncle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&#44; chlorambucil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Yoshimura<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a> 2001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41<br>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Several&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left thalamolenticular region&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pleocytosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonspecific&#46;<br>No evidence of tumor&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ben Taarit<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a> 2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26<br>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Protuberance and right cerebral peduncle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Imoto<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a> 2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No history prior to diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Basal ganglia&#44; brainstem and white matter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inflammatory cells and perivascular infiltrate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reduced size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 glucocorticoid boluses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Park<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> 2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52<br>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No history prior to diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Right cerebellar hemisphere extending to 3rd ventricle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lymphocytes 25&#47;&#956;L&#44; proteins 300<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; glucose normal&#46; No oligoclonal bands&#46; Anti-CMV and herpes simplex negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lymphocytic vasculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Initial disappearance&#46;<br>Three episodes of recurrence&#46;<br>Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&#44; azathioprine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Tuzgen<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">6</span></a> 2003</td><td class="td" title="table-entry  " align="left" valign="top">59<br>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No history prior to diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Right frontotemporal region&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gliosis&#44; panvasculitis&#44; thrombosis&#44; extensive infarction and vascular proliferation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Radiological improvement&#46; Persistent left hemiparesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Surgical excision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">45<br>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left diencephalic-mesencephalic junction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Bennett<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a> 2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left temporal lobe&#44; invading peduncle&#44; thalamus&#44; internal capsule&#44; basal ganglia and posterior corona radiata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Perivascular inflammatory infiltrate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical and radiological improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&#44; azathioprine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Matsuo<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a> 2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Basal ganglia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pleocytosis 26<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">3</span> &#40;mononuclear&#41;&#44; normal glucose and protein levels&#46; No oligoclonal bands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reactive gliosis with inflammatory infiltrate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 glucocorticoid boluses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Schmolck<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> 2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left thalamus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Radiological improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dexamethasone&#44; monthly cyclophosphamide boluses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Darmoul<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">10</span></a> 2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left thalamus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Radiological improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&#44; immunosuppressive agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Appenzeller<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a> 2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43<br>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Right thalamus&#44; lentiform nucleus&#44; subthalamic area and peduncle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gliosis with gemistocytic astrocyte&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Disappearance of the mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dexamethasone 4<span class="elsevierStyleHsp" style=""></span>mg&#47;day IV&#44; methylprednisolone 1<span class="elsevierStyleHsp" style=""></span>g&#47;3 days IV&#44; oral prednisone 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; cyclophosphamide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">K&#246;sters<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a> 2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No history prior to diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Frontoparietal region&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal cell counts&#44; glucose levels and protein levels&#46; No malignant cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lymphocytic vasculitis of small vessels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dexamethasone&#44; azathioprine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Heo<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a> 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multiple masses in left pons region and left parietal cortex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Perivascular lymphocytic infiltrate&#44; focal necrosis&#44; gliosis&#44; foamy histiocytes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reduced mass size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">High-dose glucocorticoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Varoglu<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mesencephalon&#44; bilateral basal ganglia&#44; posterior limb of internal capsule and centrum semiovale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nontumoral lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reduced lesion size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Bouomrani<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a> 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Brainstem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cyclosporine&#44; prednisone&#44; cyclophosphamide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Noel<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> 2012</td><td class="td" title="table-entry  " align="left" valign="top">57<br>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lenticulocapsular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aseptic meningitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Methylprednisolone&#44; cyclophosphamide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">47<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Peduncles&#44; basal ganglia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&#44; azathioprine&#44; cyclophosphamide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">48<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lenticulocapsular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aseptic meningitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Methylprednisolone&#44; cyclophosphamide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">34<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No history prior to diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Thalamocapsular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Necrosis with inflammatory infiltrate&#44; and infiltration by neutrophils&#44; lymphocytes and macrophages compatible with vasculitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Methylprednisolone&#44; cyclophosphamide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">30<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lenticulocapsular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aseptic meningitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prednisone&#44; cyclophosphamide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Shapiro<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">25</span></a> 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cerebral peduncle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pleocytosis with negative cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Good response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&#44; infliximab and subsequent tocilizumab with good response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Mart&#237;nez-Estupi&#241;an<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">24</span></a> 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23<br>M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cerebellum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aseptic meningitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reactive changes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Poor response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Glucocorticoids&#44; azathioprine&#44; adalimumab&#59; subsequent tocilizumab&#44; cyclophosphamide&#44; rituximab and plasmapheresis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Clinical Characteristics of the Cases Reported in the Literature&#46;</p>"
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      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:32 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Akman-Demir"
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                      "Revista" => array:6 [
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            1 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neuro-Beh&#231;et&#39;s disease&#58; epidemiology&#44; clinical characteristics&#44; and management"
                      "autores" => array:1 [
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                            0 => "A&#46; Al-Araji"
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                      "titulo" => "Beh&#231;et disease"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Simizu"
                            1 => "G&#46;E&#46; Ehrlich"
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            3 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Brain tumor-like lesion in Beh&#231;et disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Appenzeller"
                            1 => "R&#46; de Castro"
                            2 => "L&#46;S&#46; Queiroz"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00296-005-0082-3"
                      "Revista" => array:6 [
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                        "fecha" => "2006"
                        "volumen" => "26"
                        "paginaInicial" => "577"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16328418"
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            4 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Beh&#231;et syndrome&#58; a report of 41 patients with emphasis on neurological manifestations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2015.03.017

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	10	6	16
2024 October	81	38	119
2024 September	79	27	106
2024 August	107	33	140
2024 July	77	27	104
2024 June	98	31	129
2024 May	75	32	107
2024 April	76	16	92
2024 March	70	32	102
2024 February	66	20	86
2024 January	65	21	86
2023 December	66	27	93
2023 November	60	27	87
2023 October	44	27	71
2023 September	111	38	149
2023 August	66	21	87
2023 July	48	23	71
2023 June	74	25	99
2023 May	88	30	118
2023 April	43	13	56
2023 March	114	47	161
2023 February	76	34	110
2023 January	60	24	84
2022 December	79	38	117
2022 November	68	28	96
2022 October	74	46	120
2022 September	69	34	103
2022 August	49	46	95
2022 July	68	36	104
2022 June	61	34	95
2022 May	74	43	117
2022 April	77	52	129
2022 March	106	62	168
2022 February	95	35	130
2022 January	95	45	140
2021 December	55	52	107
2021 November	69	49	118
2021 October	80	74	154
2021 September	126	63	189
2021 August	81	63	144
2021 July	105	43	148
2021 June	66	37	103
2021 May	81	58	139
2021 April	207	116	323
2021 March	102	38	140
2021 February	87	35	122
2021 January	269	35	304
2020 December	50	19	69
2020 November	53	21	74
2020 October	59	22	81
2020 September	81	30	111
2020 August	48	19	67
2020 July	47	27	74
2020 June	49	23	72
2020 May	32	27	59
2020 April	28	20	48
2020 March	17	5	22
2018 May	5	1	6
2018 April	31	10	41
2018 March	39	8	47
2018 February	24	4	28
2018 January	13	4	17
2017 December	33	11	44
2017 November	16	5	21
2017 October	19	8	27
2017 September	22	15	37
2017 August	26	6	32
2017 July	30	7	37
2017 June	35	10	45
2017 May	41	14	55
2017 April	28	16	44
2017 March	19	12	31
2017 February	14	13	27
2017 January	21	11	32
2016 December	48	17	65
2016 November	47	26	73
2016 October	46	20	66
2016 September	53	8	61
2016 August	41	16	57
2016 July	20	12	32
2016 April	2	26	28

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