Cascade Sign: Expanding The Spectrum

Abstract

Background: The classical cascade sign describes the mesodiencephalic coronal hyperintense signal changes described in neuro-Behcet's disease (NBD). Material and Methods: This case series included consecutive cases having a cascade sign in brain imaging, and its aetiology with outcome were determined. Result: This case series describes the involvement of similar lesions in demyelinating disorders (multiple sclerosis, myelin oligodendrocyte glycoprotein antibody-associated disease, clinically isolated syndrome), NBD, and glioma, thereby extending the spectrum. The clinical presentation can be varied with focal neurological deficit, tremors, ataxia, seizure, dysphagia, dysarthria, and behavioural abnormality. Conclusion: The cascade sign could be a phenomenon beyond NBD.