Pattern of MRI brain abnormalities in rheumatic patients with neurological involvement: a tertiary care teaching hospital experience

To explore the pattern of abnormalities seen on MRI in rheumatic patients with neurological manifestations and to interpret the findings in relation to clinical picture. Descriptive study. Rheumatology unit, King Khalid University Hospital, Riyadh, Saudi Arabia from January 2013 to February 2014. We prospectively included rheumatic patients with neurological symptoms and signs. The clinical data were correlated with MRI findings by a team comprising of a rheumatologist, neurologist and neuro-radiologist. Data was analyzed using simple statistical analysis. Fifty patients were recruited with a mean age of 36.4 +/- 10.76 years [range 17-62]. Among SLE patients with seizures, focal deficit and headache white matter hyperintensities were found in 9 [64.28%], 4 [50%], 4 [80%] patients respectively. Out of seven SLE patients with global dysfunction, 3 [42.85%] had brain atrophy and 2 [28.57%] normal MRI. In Behcet's disease with focal deficit, 3 [75%] patients had white matter hyperintensities and 1 [25%] had brainstem involvement. In Behcet's disease with headache, 2 [50%] had normal MRI, 1 [25%] brainstem hyper-intensities and 1 [25%] had subacute infarct. Two [66%] of three Primary APS patients had white matter hyperintensities while third [33%] had old infarct. Both patients of polyarteritisnodosa, had white matter hyperintensities. Out of two Wegener's granulomatosis one had white matter hyperintensities and other had ischemic changes in optic nerves. The only one scleroderma patient had white matter hyperintensities. We found that white matter hyperintensities was the most common MRI abnormality in our study group which in most of the cases had poor clinical correlation. No distinct pattern of CNS involvement on MRI was observed in various rheumatic disorders

Syringomyelia: a diagnosis challenge

Syringomyelia is a chronic progressive degenerative disease of the spinal cord which can present with a peculiar neurological features other than the classical brachial amyotrophy and segmental sensory loss of dissociated type. Occasionally, it is present with variable clinical features and can easily be missed as the familiar symptoms and signs of the disease are absent. The diagnostic suspicion is undermined if the patient has other body anomalies which are known to be associated with syringomyelia. We are presenting two cases that illustrate such a diagnostic dilemma and suggest that magnetic resonance imaging [MRI] of the spinal cord should be done in cases lacking the classical features of s ring. omyelia even if the index of suspicion is low