CNS lupus, Systemic Lupus (SLE) in the brain and / or spinal cord 4.33/5 (6)

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Cerebral Lupus / Neuropsychiatric SLE with MRI changes in the brain: Wang HP, Chin Med J, 2016. CC BY-NC-SA 3.0

Definition

Signs of disease in the brain and / or spinal cord may be due to Systemic lupus erythematosus (SLE). Generally, changes are shown in various tests / investigations.

Examinations

  • Antibody in serum and spinal fluid: Anti-ribosomal P and antifosfolipid antibodies are associated with neuropsychiatric SLE
  • MRI of the brain recommended for suspicion of focal neurological changes, seizures, chronic cognitive failure and Antiphospholipid syndrome. However, MRI changes are not easy to interpret (Reference: Kim KW, 2008)
    Changes in white matter are present in healthy population under 50 years at approximately 20%

    • At age over 70 years, 90% has such MRI changes
    • SLE and MRI changes in white matter:
      • For about. 50% is normal MR normal, although neuropsychiatric lupus is present
      • Small infarct changes may resemble Multiple sclerosis (MS). Increased incidence at Antiphospholipid syndrome. The changes correlate poorly with SLE activity
      • Major MRI lesions in the brain can correlate with SLE activity (SLEDAI score)
      • In case of acute convulsions, psychosis or coma there are signs of brain edema
      • "Dynamic susceptibility contrast-enhanced T2-weighted perfusion MRI (DSC-MRI)" is a special study used at some centers
      • More about MRI examination of the brain at SLE here (reference: Sarbu N, 2015)
    • Electro encephalogram (EEG)
      • 80% with active CNS lupus have pathological changes (slow waves, focal changes)
    • Spinal Fluid examination
        • Routine examinations may be normal. Special tests are aDNA, IgG and immune complexes)
    • Neuropsychological tests
        • These may be useful for mapping and as a basis for later inspection.
    • PET / CT can be used

Different types of nerve manifestations

  • Neuropsychiatric symptoms
    • Cognitive problems (attention, memory, control of emotions, reduced pace) described at 20-80% with SLE
    • Anxiety
    • Depressed mood / depression
    • Headache (most often migraine or tension headache) is common in the population as well. New headache at SLE is considered for sinus vein thrombosis (Especially at Antifosfolipid antibodies)
    • Psychosis
      • Serious manifestation with a loss of reality experience
      • SLE-conditioned psychosis is distinguished from psychosis triggered by corticosteroids (eg Prednisolone more than 40mg / day)
  • Epileptic cramps
    • Occurs among 10-20% with CNS lupus
    • May be debut symptom at SLE
    • Often related to SLE activity or old, larger scar changes in the brain
    • Increased incidence of antifosfolipid antibodies
  • By Antiphospholipid syndrome (with increased risk of blood clots (thromboembolisms)) injury may occur independently of SLE activity. Neurological symptoms may be
    • TIA and / or stroke
    • Vascular dementia
    • Convulsions
    • Sinus-vein thrombosis (headache)
    • Coordination Problem
    • Headache
  • Transverse myelitis
    • Sudden weakness in lower extremities and / or sensitivity loss
    • Loss of control over urine and faeces (sphincter paresis) occurs
    • Most often at the same time as high SLE activity
    • Investigation with MRI investigations showing disease signs

Diagnosis

  • Disease history
  • Investigational Findings
  • If investigations do not show signs of disease, the diagnosis depends on the expert's overall assessment

Incorrect diagnosis? (Similar diseases / differential diagnoses)

Literature


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