Pontine Infarction and Vertebral Artery Dissecting Aneurysm as the First Presentation of Behçet’s Disease: A Case Report

Behçet’s disease (BD) is a systemic disease of inflammatory origin that appears most often in the third or fourth decade of life. Behçet’s disease is hallmarked predominantly by mucocutaneous lesions and ocular involvement. Vertebral artery dissection and neurological manifestations are rare complications in Behçet’s disease. We examine the case of a medically free 33-year-old male who was admitted to the emergency department complaining of sudden-onset dizziness, vomiting, and tinnitus. Neurological examination revealed fluctuating consciousness, multiple gaze nystagmus, motor deficit in the upper and lower limbs, bilateral Babinski sign, and truncal ataxia. Magnetic resonance imaging (MRI) showed a right pontine hyperintense lesion on T2-weighted images (T2WI). A right vertebral angiogram four months after the incident showed a dissection in the mid-cervical third of an anomalous duplicated origin arm of the right vertebral artery. This case describes an uncommon form of initial presentation of Behçet’s disease via a pontine infarction triggered by a dissecting aneurysm in an anatomically rare variant of the vertebral artery.