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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">Neuro-Beh&#231;et &#40;NB&#41; is the product of the primary impact of Beh&#231;et&#39;s disease on the CNS&#44; systemic manifestations of neurological complications or it may be secondary to treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Immunological studies of cerebrospinal fluid &#40;CSF&#41; in this entity were confined to the quantifying of some immunoglobulins&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The Reibergram makes an integrated analysis of the functioning of the blood&#47;CSF barrier and the intrathecal synthesis of immunoglobulins from serum and LCF coupling &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This method is a useful tool for diagnosing diseases which involve the CNS&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#44;5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this article is to assess the neuroimmunological response through the Reibergram in a patient with NB&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Case</span><p id="par0025" class="elsevierStylePara elsevierViewall">We report the case of a female&#44; Caucasian patient aged 16 who presented with headaches &#40;occipital&#41; and back pain on the left side of her body&#44; of 15days onset&#46; Five days later she suffered from dizziness and paresia on the left side of her body which made walking impossible&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Neurological examination highlighted cranial nerve VI paralysis and bilateral papilloedema&#46; Four days after admittance an ulcer appeared in the labia majora region&#44; and the patient was questioned again and stated having a prior history of oral aphthous ulcers on at least 3 occasions in the last year&#44; which were not resolved with standard treatment and which disappeared spontaneously&#46; The pathergy skin test was positive&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Erythrocite sedimentation rate&#58; 84<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#46; Blood chemistry&#44; complete haemogram and coagulation profile tested within normal parameters&#46; Computerised tomography informed of diffuse cortical atrophy&#44; and cytochemical&#44; microbiological and cytological analyses of the CSF produced normal results&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">IgG&#44; IgA&#44; IgM and albumin concentration were quantified in serum and CSF by single radial immunodiffusion&#46; The result of this neuroimmunological study revealed intrathecal synthesis for the three classes of the largest immunoglobulins&#44; as a synthesis pattern&#44; without any impairment of the blood&#47;CSF barrier&#44; concluding that this was an inflammatory process of the CNS &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; Reibergram 1&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The patient was diagnosed with NB and treatment was administered with methylprednisolone to which she responded favourably&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Four months later the patient had a relapse with neurological symptoms &#40;paralysis of the <span class="elsevierStyleSmallCaps">iii</span>&#44; <span class="elsevierStyleSmallCaps">iv</span>&#44; <span class="elsevierStyleSmallCaps">vi</span> and <span class="elsevierStyleSmallCaps">v</span>&#8212;ophthalmic branch&#8212;cranial nerves&#41; and ophthalmological nerves &#40;anterior uveitis and chronic bilateral papilloedema&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Erythrocite sedimentation rate&#58; 93<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#59; the other ancillary tests were normal&#46; The patient was referred for neuroimmunological analysis&#44; which revealed intrathecal synthesis for the three largest immunoglobulins as a synthesis pattern&#44; without any impairment of the blood&#47;CSF barrier&#44; concluding that this was an inflammatory process of the CNS &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; reibergram 2&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Due to the clinical symptoms of the patient&#44; the results from the ancillary tests and the background of NB&#44; this was interpreted as an exacerbation or outbreak of the disease&#46; Treatment was administered with methylprednisolone&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">CSF studies in patients with NB have reported the increase in pro-inflammatory cytokines&#44; particularly interleukin 6&#44; which is characteristic of the active phase of the illness&#44; playing a major role in the processes of neuronal damage and neuroapoptosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Secondary to the autoimmune processes in Beh&#231;et&#39;s disease&#44; we find the deposit of inmunoglobulins&#44; demonstrated by immunofluorescence&#46; Of these&#44; the endothelial anticellular&#44; anti-kinectin and antinuclear antibodies are the ones with a key function in the physiopathology of this vasculitis and are one of the causes of tissue damage&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#8211;8</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">This patient presented with a pattern of intrathecal synthesis for the three classes of immunoglobulins in both exacerbations of the disease&#46; However&#44; there was no dysfunction of the blood&#47;CSF barrier&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">We suggest that this barrier is highly relevant&#44; since it not only limits access of circulating molecules towards the brain&#44; but also limits access towards the brain of antigens from the systemic immune system&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The latter is an indicator of complete disease remission and this corresponded with the course of this disease in our clinical case patient&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0090" class="elsevierStylePara elsevierViewall">The findings from this case are the first study where the Reibergram was used to assess the neuro-immunological response in a patient with NB&#44; 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Case Report
Neuroimmunological Response in Neuro-Behçet's
Respuesta neuroinmunológica en neuro-Behçet
Alexis Alejandro Garcia-Riveroa, Javier Gonzalez-Argotea,
Corresponding author
jargote@infomed.sld.cu

Corresponding author.
, José Pedro Martínez Larrarteb, Ivonne Margarita Iglesias Gonzálezb, Alberto Juan Dorta-Contrerasb
a Instituto de Ciencias Básicas y Preclínicas Victoria de Girón, Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
b Laboratorio Central del Líquido Cefalorraquídeo (LABCEL), Facultad de Ciencias Médicas Miguel Enríquez, Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
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1</a>&#41;&#46; This method is a useful tool for diagnosing diseases which involve the CNS&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#44;5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this article is to assess the neuroimmunological response through the Reibergram in a patient with NB&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Case</span><p id="par0025" class="elsevierStylePara elsevierViewall">We report the case of a female&#44; Caucasian patient aged 16 who presented with headaches &#40;occipital&#41; and back pain on the left side of her body&#44; of 15days onset&#46; Five days later she suffered from dizziness and paresia on the left side of her body which made walking impossible&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Neurological examination highlighted cranial nerve VI paralysis and bilateral papilloedema&#46; 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as a synthesis pattern&#44; without any impairment of the blood&#47;CSF barrier&#44; concluding that this was an inflammatory process of the CNS &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; Reibergram 1&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The patient was diagnosed with NB and treatment was administered with methylprednisolone to which she responded favourably&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Four months later the patient had a relapse with neurological symptoms &#40;paralysis of the <span class="elsevierStyleSmallCaps">iii</span>&#44; <span class="elsevierStyleSmallCaps">iv</span>&#44; <span class="elsevierStyleSmallCaps">vi</span> and <span class="elsevierStyleSmallCaps">v</span>&#8212;ophthalmic branch&#8212;cranial nerves&#41; and ophthalmological nerves &#40;anterior uveitis and chronic bilateral papilloedema&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Erythrocite sedimentation rate&#58; 93<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#59; the other ancillary tests were normal&#46; The patient was referred for neuroimmunological analysis&#44; which revealed intrathecal synthesis for the three largest immunoglobulins as a synthesis pattern&#44; without any impairment of the blood&#47;CSF barrier&#44; concluding that this was an inflammatory process of the CNS &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; reibergram 2&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Due to the clinical symptoms of the patient&#44; the results from the ancillary tests and the background of NB&#44; this was interpreted as an exacerbation or outbreak of the disease&#46; Treatment was administered with methylprednisolone&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">CSF studies in patients with NB have reported the increase in pro-inflammatory cytokines&#44; 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However&#44; there was no dysfunction of the blood&#47;CSF barrier&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">We suggest that this barrier is highly relevant&#44; since it not only limits access of circulating molecules towards the brain&#44; but also limits access towards the brain of antigens from the systemic immune system&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The latter is an indicator of complete disease remission and this corresponded with the course of this disease in our clinical case patient&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0090" class="elsevierStylePara elsevierViewall">The findings from this case are the first study where the Reibergram was used to assess the neuro-immunological response in a patient with NB&#44; and its use may therefore be indicated for the active phase of the disease&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical Liabilities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of people and animals</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed comply with the ethical standards of the Committee responsible for human experimentation and are in keeping with the World Medical Association and the Declaration of Helsinki&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Data confidentiality</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare they have followed the protocols of their centre of work on patient data publication&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of Interests</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare with regard to this article&#46;</p></span></span>"
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Article information
ISSN: 21735743
Original language: English
DOI:10.1016/j.reumae.2017.02.004
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2021 October 96 58 154
2021 September 60 46 106
2021 August 52 31 83
2021 July 36 36 72
2021 June 56 32 88
2021 May 68 45 113
2021 April 150 98 248
2021 March 86 27 113
2021 February 59 23 82
2021 January 57 28 85
2020 December 51 26 77
2020 November 76 30 106
2020 October 52 20 72
2020 September 73 39 112
2020 August 46 32 78
2020 July 51 17 68
2020 June 63 22 85
2020 May 43 19 62
2020 April 34 16 50
2020 March 43 4 47
2019 September 1 0 1
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