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ABSTRACT Introduction: Transcranial Doppler ultrasonography (TCD) is a technique that allows measurement of blood flow from the basal intracerebral vessels. It is relatively inexpensive, non-invasive, can be performed at the bedside, and allows monitoring in acute emergency settings and for prolonged periods with a high temporal resolution, making it ideal for studying the haemodynamics within the intracranial arteries in neuro-Behcet's disease (NBD) and neuro-psychiatric lupus (NPSLE). Our aim was to assess the cerebral haemodynamic patterns in patients with NBD and NPSLE using TCD, while brain lesions were examined using magnetic resonance imaging (MRI). Material and methods: Case-control prospective study of 30 neuro-Behcet's disease patients, 25 neuro-psychiatric lupus patients and 26 healthy age-matched volunteers. All patients and healthy controls were examined by TCD. Only the groups of patients underwent cranial magnetic resonance imaging (MRI). Results: Transcranial Doppler (TCD) values for middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), vertebral artery (VA) and basilar artery (BA) in NBD, NPSLE and control groups were measured. The results showed that there was a significant decrease in mean blood flow velocities in all the arteries examined in NBD and NPSLE patients. There was also a significant increase in the pulsatile index of PCA, VA and BA between NBD and NPSLE patients. The same results were obtained when comparing NBD versus controls. However, there was no significant difference between the NPSLE patients and the control group. The MRI lesions described were parenchymal lesions in 14 patients (46.7%), and vascular lesions in 4 patients (13.3%). Vascular lesions co-existed with parenchymal lesions (mixed lesion). Parenchymal lesions were in white matter (40%), thalamus (26.7%), brain stem (26.7%) and cerebellum (20%). While, in NPSLE, 23 patients were normal (92%) and only two patients had a vascular lesion (8%). Conclusion: There was a significant decrease in mean blood flow and a significant increase in the pulsatile index among both NBD and NPSLE patients, according to the TCD values.
Subject(s)
Humans , Male , Female , Adult , Infections , Stomatognathic Diseases , Central Nervous System Infections , Behcet Syndrome , Lupus Vasculitis, Central Nervous System , Mouth DiseasesABSTRACT
Introduction: Neuropsychiatric Systemic LupusErythematosus (NPSLE) is a disease with central andperipheral nervous system manifestations. The diagnosis ofNPSLE is often a diagnostic challenge though the criteria forNPSLE is well-established.Objective: To study the prevalence and pattern ofneuropsychiatric manifestations in SLE.Materials and Methods: This hospital based observationalstudy was carried out from Nov 2017 to June 2018. A total of58 cases of SLE were assessed clinically and investigatedaccordingly. Special emphasis was given to look forNeurological involvement. MMSE, HAM A and HAM D scaleswere used for assessment of cognitive dysfunction, anxiety anddepression respectively. The disease activity was measured bythe SLEDAI.Results: In a total of 58 patients with SLE evaluated, 92%were female. The most common age group was 21 to 30 years.Mean age was 25.6 years. Nervous system involvement wasfound in 37 (63.79%) patients. Headache was the mostfrequent manifestation, present in 32 (55.17%) patientsfollowed by Cognitive dysfunction in 8 patients (13.79%).Seizure disorder was present in 6 (10.34%), acute confusionalstate in 2 (3.44%), depression in 4 (6.89%), anxiety in 2(3.44%) and psychosis in 2 (26.31%) patients. Asepticmeningitis and peripheral neuropathy was found in 2 (3.44%)and 1 (1.72%) patients respectively. Many of the patients hadmore than one neurological involvement. SLEDAI score washigh in SLE patients with neurological manifestations.Conclusion: The frequency of Neuropsychiatric involvementwas found in the majority of the patients with SLE andheadache was the most common manifestation. Patients withNPSLE showed high disease activity.
ABSTRACT
Neuropsychiatric systemic lupus erythematosus (NPSLE) involves the central and peripheral nervous system in patients with systemic lupus erythematosus (SLE). It is essential to specify the problems faced by patients with NPSLE because it causes diverse disabilities and impairs quality of life. After performing a comprehensive evaluation, tailored management should be provided for the patient's specific problems. We report here the case of a 30-year-old female with SLE who experienced serious neuropsychiatric symptoms cerebral infarction followed by posterior reversible encephalopathy syndrome and peripheral polyneuropathy. We systemically assessed the patient using the International Classification of Functioning, Disability and Health model as a clinical problem-solving tool and provided comprehensive rehabilitation by focusing on her problems.
Subject(s)
Adult , Female , Humans , Cerebral Infarction , International Classification of Functioning, Disability and Health , Lupus Erythematosus, Systemic , Lupus Vasculitis, Central Nervous System , Peripheral Nervous System , Polyneuropathies , Posterior Leukoencephalopathy Syndrome , Quality of Life , RehabilitationABSTRACT
The clinical manifestations of nervous system involvement in systemic lupus erythematosus (SLE) are highly diverse and their pathogenic mechanisms are incompletely understood. Neuropsychiatric SLE (NPSLE) poses difficulty in making the proper diagnosis, especially in circumstances where its initial symptoms are diffuse neuropsychiatric symptoms. We describe a 43-year old woman who exhibited a myoclonic jerk of the abdominal wall, followed shortly by acute confusion, which was attributed to SLE. Therapy with high dose corticosteroids completely reversed the symptoms. Myoclonus can be an anticipatory symptom of diffuse neurologic dysfunction in patients with NPSLE.
Subject(s)
Female , Humans , Abdominal Wall , Adrenal Cortex Hormones , Central Nervous System , Lupus Erythematosus, Systemic , Lupus Vasculitis, Central Nervous System , Myoclonus , Nervous System , Neurologic ManifestationsABSTRACT
OBJECTIVE: To investigate the usefulness of 1H-magnetic resonance spectroscopy (1H-MRS) for the early diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE). METHODS: Magnetic resonance image (MRI) and 1H-MRS were performed on fifteen normal volunteers (mean age, 29+/-6 years; age range, 24~40 years) and twenty seven patients with SLE: twelve (26+/-8 years; 16~42 years) with and fifteen (32+/-12 years; 13~57 years) without NPSLE. The localized 1H-MRS was performed by a GE 1.5T SIGNA MRI/MRS system (version 5.5) with active shielded gradients. For all spectra, a Stimulated Echo Acquisition Method (STEAM) localization sequence with three-pulse CHESS H2O suppression was used. The metabolite ratios of N-acetylaspartate (NAA) to creatine (Cr) and choline (Cho) to Cr measured on 1H-MRS of the basal ganglia (BG) and peritrigonal periventricular white matter (PWM). RESULTS: The level of disease activity makers (anti-dsDNA, C3, C4, SLEDAI score), autoantibodies (lupus anticoagulant, anticardiolipin antibody, antiribosomal-P), and EEG did not showed significant difference between the patients without NPSLE and with NPSLE (p>0.05). Thirteen percent (2/15) of patients without NPSLE and fifty percent (6/12) of patient with the NPSLE showed abnormality in MRI. 1H-MRS showed significantly decreased NAA/Cr ratio in BG and increased Cho/Cr ratio in PWM for the patients with NPSLE compared to the patients without NPSLE and normal volunteers (p0.05). But negative correlation was shown between NAA/Cr in BG and Cho/Cr ratio in PWM (r=-0.58, p<0.05). CONCLUSION: NAA/Cr ratio in BG was decreased and Cho/Cr in PWM was increased in NPSLE. The neurometabolite ratio measured by 1H-MRS may be useful in the early detection of NPSLE.
Subject(s)
Humans , Antibodies, Anticardiolipin , Autoantibodies , Basal Ganglia , Choline , Creatine , Early Diagnosis , Electroencephalography , Healthy Volunteers , Lupus Vasculitis, Central Nervous System , Magnetic Resonance Imaging , Spectrum AnalysisABSTRACT
OBJECTIVE: To investigate the usefulness of 1H-magnetic resonance spectroscopy (1H-MRS) for the early diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE). METHODS: Magnetic resonance image (MRI) and 1H-MRS were performed on fifteen normal volunteers (mean age, 29+/-6 years; age range, 24~40 years) and twenty seven patients with SLE: twelve (26+/-8 years; 16~42 years) with and fifteen (32+/-12 years; 13~57 years) without NPSLE. The localized 1H-MRS was performed by a GE 1.5T SIGNA MRI/MRS system (version 5.5) with active shielded gradients. For all spectra, a Stimulated Echo Acquisition Method (STEAM) localization sequence with three-pulse CHESS H2O suppression was used. The metabolite ratios of N-acetylaspartate (NAA) to creatine (Cr) and choline (Cho) to Cr measured on 1H-MRS of the basal ganglia (BG) and peritrigonal periventricular white matter (PWM). RESULTS: The level of disease activity makers (anti-dsDNA, C3, C4, SLEDAI score), autoantibodies (lupus anticoagulant, anticardiolipin antibody, antiribosomal-P), and EEG did not showed significant difference between the patients without NPSLE and with NPSLE (p>0.05). Thirteen percent (2/15) of patients without NPSLE and fifty percent (6/12) of patient with the NPSLE showed abnormality in MRI. 1H-MRS showed significantly decreased NAA/Cr ratio in BG and increased Cho/Cr ratio in PWM for the patients with NPSLE compared to the patients without NPSLE and normal volunteers (p0.05). But negative correlation was shown between NAA/Cr in BG and Cho/Cr ratio in PWM (r=-0.58, p<0.05). CONCLUSION: NAA/Cr ratio in BG was decreased and Cho/Cr in PWM was increased in NPSLE. The neurometabolite ratio measured by 1H-MRS may be useful in the early detection of NPSLE.