İdiopatik Intracranial Hipertansiyonda Serebral Venöz Sinüz Trombozu Olmaksızın Behçet Hasatalığı: Üçüncü Basamak Bir Baş Ağrısı Merkezinin Retrospektif Sonuçları

Öz

Kliniğimizde idiyopatik intrakranial hipertansiyonlu (İİH) hastalarda sıklıkla serebral ven trombozu olmaksızın Behçet hastalığının (BH) eşlik ettiğini gözlemledik. Bu çalışmada, İİH'li hastalarda izole BH prevalansını araştırmayı amaçladık. İİH’li hastalara tanı aşamasında "Eşlik eden bir hastalığınız var mı?" sorusu soruldu. BH olduğunu beyan eden hastaların tanıları romatolog tarafından konfirme edildi, hastalık tanısı doğulandı. BH komorbiditesi olanlarin radyolojik görüntüleri tekrar tecrubeli bir nöroradyolog tarafından gözden geçirilerek nöro-Behçet hastalığı (NBH) ekaret edildi. Doksansekiz İİH hastasının 4'üne (%4,1) izole BH tanısı konuldu. Hastalardan 92'si kadın (%93,9), 6'sı erkekti (%6,1). Hastaların yaş ortalaması 36,7±12 (18-65) yıl, vücut kitle indeksi (VKİ) ortalamaları 32,39 (21-49) kg/m2’di. Dört BH’li hasta da kadındı. BH'li hastalar ile BH'siz hastalar arasında cinsiyet açısından anlamlı bir fark yoktu (p=1,0). BH'li hastaların yaş ortalaması 43,50, BH'siz hastaların yaş ortalaması 36,41 yıldı ve aralarında anlamlı bir fark yoktu (p=0,167). BH'li İİH hastalarının ortalama VKİ'si 35,4 kg/m2 iken, BH'siz IIH hastalarının ortalama VKİ'si 32,26 kg/m2’ydi. Aralarında anlamlı bir fark bulunmadı (p=0,323). İİH hastalarında %4,1 oranında BH prevalansı saptadık. BH endemik olduğu bölgelerde İİH hastalarında BH semptomlarının sorgulanmasını öneriyoruz.

Anahtar Kelimeler

• Behçet Hastalığı
• idiopatik intrakranial hipertansiyon
• inflamasyon
• komorbidite

Destekleyen Kurum

Yok

Etik Beyan

Bu çalışma hastanemizin kurumsal etik kurulu tarafından onaylandı (onay no: AEŞH-EKI-2023-566; onay tarihi: 22.11.2023); ve bu retrospektif çalışma için bilgilendirilmiş onam gerekmedi.

Teşekkür

Yok

Behçet's Disease in Idiopathic Intracranial Hypertension Without Cerebral Venous Sinus Thrombosis: Retrospective Results of a Tertiary Headache Center

Öz

In our clinic, we frequently observed the comorbidity of Behçet's disease (BD) without cerebral vein thrombosis in patients with idiopathic intracranial hypertension (IIH). This study aimed to investigate the comorbidity of isolated BD in patients with IIH. The medical records of 98 patients diagnosed with IIH were retrospectively reviewed. IIH was diagnosed by an experienced neurologist. At the diagnosis stage, patients who responded to the question "Do you have any comorbidities?" with a statement of BD had their diagnoses confirmed by a rheumatologist. The radiological images of patients diagnosed with BD were reconfirmed by a neuroradiologist, and neuro-Behçet's (NBD) disease was excluded. Isolated BD was diagnosed in 4 of 98 IIH patients (4.1%). Ninety-two of the IIH patients were female (93.9%). The mean age of the patients was 36.7±12 (18-65) years, and their mean body mass index (BMI) was 32.39 (21-49). Four BD patients were female. There was no significant difference between those with BD and those without BD regarding gender (p= 1.0). The average age of those with BD was 43.50, and the average age of those without BD was 36.41, and there was no significant difference between them (p=0.167). The mean BMI of IIH patients with BD was 35.40, while the mean BMI of IIH patients without BD was 32.26. No significant difference was found between them (p=0.323). We found a 4.1% prevalence of BD in patients with IIH. We recommend questioning IIH patients for BD symptoms in regions where BD is endemic.

Anahtar Kelimeler

• Behçet's Disease
• Idiopathic Intracranial Hypertension
• comorbidity
• inflammation

Destekleyen Kurum

No

Etik Beyan

This study was approved by the institutional ethics committee of our hospital (approval No: AEŞH-EKI-2023-566; approval date: 22.11.2023); and informed consent was not required for this retrospective study.

Teşekkür

No

Kaynakça

1. 1. Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013; 81(13): 1159–1165.
2. 2. Biousse V, Bruce BB, Newman NJ. Update on the pathophysiology and management of idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry. 2012;83(5):488-494.
3. 3. Markey KA, Mollan SP, Jensen RH, et al. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol. 2016;15:78-91.
4. 4. Mollan SP, Aguiar M, Evison F, Frew E, Sinclair AJ. The expanding burden of idiopathic intracranial hypertension. Eye. 2019; 33(3): 478-485.
5. 5. Ireland B, Corbett JJ, Wallace RB. The search for causes of idiopathic intracranial hypertension: a preliminary case–control study. Arch Neurol. 1990;47:315-320.
6. 6. Sinclair AJ, Ball AK, Burdon MA, et al. Exploring the pathogenesis of IIH: An inflammatory perspective. J Neuroimmunol. 2008;15:201-202:212–220.
7. 7. Ceylan OM, Yılmaz M, Yilmaz H, Çelikay O, Köylü MT, Turan A. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammation markers in patients with papilledema due to idiopathic intracranial hypertension. Indian J Ophthalmol. 2021;69(6):1499–1505.
8. 8. Sundholm A, Burkill S, Waldenlind E, Bahmanyar S, Nilsson Remahl AIM. Infectious and inflammatory disorders might increase the risk of developing idiopathic intracranial hypertension-A national case-control study. Cephalalgia. 2020;40:1084–94.

9. 9. Behçet H. Über rezidivierende, aphtöse, durch ein Virus verursachte Geschwüre am Mund, am Auge und an den Genitalien. Derm Wschr. 1937;105:1152–1157.
10. 10. Çölgeçen E, Özyurt K, Ferahbaş A, et al. The prevalence of Behçet's disease in a city in Central Anatolia in Turkey. Int J Dermatol. 2015;54(3):286-289.
11. 11. Ideguchi H, Suda A, Takeno M, et al. Neurological manifestations of Behçet’s disease in Japan: a study of 54 patients. J Neurol. 2010;257:1012–1020.
12. 12. Uygunoglu U, Siva A. An uncommon disease included commonly in the differential diagnosis of neurological diseases: Neuro-Behçet’s syndrome. J Neurol Sci. 2021;426:117436.
13. 13. Keskin AO , İdiman F, Kaya D, Bircan B. Idiopathic Intracranial Hypertension: Etiological factors, Clinical Features, and Prognosis. Arch Neuropsychiatry 2020;57:23−26
14. 14. Wu Y, Yin W, Liu S, Wang S, Ding Y. Diagnosis and management of Neuro-Behçet disease with isolated intracranial hypertension: a case report and literature review. BMC Neurol. 2023;23:335.
15. 15. Houman MH, Hamzaoui-B'Chir S, Ben Ghorbel I, et al Neurologic manifestations of Behcet's disease: analysis of a series of 27 patients. Rev Med Interne. 2002;23(7):592-606.
16. 16. Criteria for diagnosis of Behcet’s disease. International Study Group for Behcet’s Disease. Lancet. 1990;335:1078-1080.
17. 17. Yilmaz-Can F. Panpalli-Ates M. Investigation of the Frequency of Cerebral Transverse Venous Sinus Stenosis in Idiopathic Intracranial Hypertension. J Basic Clin Health Sci. 2021; 3:132-136.
18. 18. Mollan SP, Grech O, Alimajstorovic Z, Wakerley BR, Sinclair AJ. New horizons for idiopathic intracranial hypertension: advances and challenges. Br Med Bull. 2020;136(1):118-126.
19. 19. Hirohata S, Kikuchi H, Sawada T, et al. Clinical characteristics of neuro-Behçet's disease in Japan: a multicenter retrospective analysis. Mod Rheumatol. 2012;22(3):405-13.
20. 20. Press OW, Ladenson PW. Pseudotumor cerebri and hypothyroidism. Arch Intern Med. 1983;143(1):167-8.
21. 21. Komura K, Sato S, Ishida W, Fujii H, Takehara K. Idiopathic intracranial hypertension with elevated cerebrospinal fluid level of interleukin-6 in a patient with systemic lupus erythematosus. Clin Rheumatol. 2002;21:267–268.
22. 22. Lampl Y, Eshel Y, Kessler A, et al. Serum leptin level in women with idiopathic intracranial hypertension. J. Neurol. Neurosurg. Psychiatry. 2002;72, 642–643.
23. 23. Sudhakar P. Commentary: The role of inflammation in idiopathic intracranial hypertension. Indian J Ophthalmol. 2021;69(6): 1506–1507.
24. 24.Kim JM, Kwok SK, Ju JH, Kim HY, Park SH. Idiopathicintracranial hypertension as a significant cause of intractableheadache in patients with systemic lupus erythematosus: a 15-year experience. Lupus. 2012;21(5):542–547.
25. 25.Green L, Vinker S, Amital H, et al. Pseudotumor cerebri insystemic lupus erythematosus. Semin Arthritis Rheum.1995;25:103–108.