Case report http://dx.doi.org/10.3345/kjp.2012.55.9.354 Korean J Pediatr 2012;55(9):354-357 eISSN 1738-1061 • pISSN 2092-7258 Neuro -Behçet disease presented diplopia with hemiparesis following minor head trauma Ja Yun Choi, MD1, Sun Young Park, MD1, In Ok Hwang, MD2, Young Hwan Lee, MD, PhD1 1Department of Pediatrics, Yeungnam University College of Medicine, Daegu, 2Department of Pediatrics, CHA Gumi Medical Center, Gumi, Korea Received: 10 August 2011, Revised: 14 November 2011 Accepted: 31 January 2012 Corresponding author: Young Hwan Lee, MD, PhD Department of Pediatrics, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 705-717, Korea Tel: +82-53-620-4381, Fax: +82-53-629-2252 E-mail: yhlee@med.yu.ac.kr Behçet disease (BD) is rare in childhood. We report a 9-year-old boy with neuro-Behçet disease who presented diplopia and weakness on the left side after a cerebral concussion. Brain magnetic resonance imaging (MRI) revealed hyperintensity of the right mesodiencephalic junction on T2-weighted and fluid attenuated inversion recovery images. Prednisolone administration resulted in complete remission and normalization of abnormal MRI finding. Brain MRI is a useful diagnostic tool when the neurological sign is the first symptom of subclinical BD. Key words: Neuro-Behçet disease, Cerebral concussion, Child Copyright © 2012 by The Korean Pediatric Society This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by- nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction Behçet disease (BD) is characterized by recurrent aphthous oral and genital ulcerations, uveitis, and systemic inflammation. This disease may include skin, joints, gastrointestinal tract, central nervous system (CNS), and other organs1). The nervous system involvement is one of the most serious manifestations of BD, leading to headache, confusion, paresis, cranial nerve palsy, cerebellar ataxia, or meningeal irritation signs. Neurological complications occur in about 5 to 25% of all patients with BD2). Neuro-Behçet disease (NBD) may be difficult to be diagnosed in patients without full-blown feature of BD. We present a case of child with NBD, in whom signs and symptoms suggest CNS involvement after brain concussion. Here we discuss the triggering factors that develop the typical symptoms of NBD in patients who do not fulfill criteria for BD (International Study Group for Behçet disease, 1990) (Table 1)3). Furthermore, we emphasize the value of magnetic resonance imaging (MRI) findings in the diagnosis of NBD. Case report A 9-year-old boy was transferred to our department in March 2007 with diplopia and left sided weakness after minor head injury. He was previously healthy and had no history of neurological disease. While playing, he was pushed by a boy and fell down on the ground by the back side of his head. He was not unconscious or disorientated but complaining of headache for some minutes and fell asleep. Next morning, sixteen hours later, he was found to have diplopia and left sided weakness. He had recurrent oral aphthous ulcer and intermittent multiple joint pain in the past according to patient’s recall. 354