eMedicine Specialties > Neurology > Inflammatory and Demyelinating Diseases

Systemic Lupus Erythematosus: Multimedia

Author: Tarakad S Ramachandran, MBBS, FRCP(C), FACP, Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital
Coauthor(s): James Santiago Grisolia, MD, Active Staff, Scripps Mercy Hospital
Contributor Information and Disclosures

Updated: Oct 30, 2008

Multimedia

This axial, T2-weighted brain MRI demonstrates an...
(Enlarge Image)
Media file 1: This axial, T2-weighted brain MRI demonstrates an area of ischemia in the right periventricular white matter of a 41-year-old woman with longstanding systemic lupus erythematosus (SLE). She presented with headache and subtle cognitive impairments but no motor deficits. Faintly increased signal intensity was also seen on T1-weighted images, with a trace of enhancement following gadolinium that is too subtle to show on reproduced images. Distribution of the abnormality is consistent with occlusion of deep penetrating branches, such as may result from local vasculopathy, with no clinical or laboratory evidence of lupus anticoagulant or anticardiolipin antibody. Cardiac embolus from covert Libman-Sacks endocarditis remains less likely due to distribution.
[ CLOSE WINDOW ]
This axial, T2-weighted brain MRI demonstrates an...

This axial, T2-weighted brain MRI demonstrates an area of ischemia in the right periventricular white matter of a 41-year-old woman with longstanding systemic lupus erythematosus (SLE). She presented with headache and subtle cognitive impairments but no motor deficits. Faintly increased signal intensity was also seen on T1-weighted images, with a trace of enhancement following gadolinium that is too subtle to show on reproduced images. Distribution of the abnormality is consistent with occlusion of deep penetrating branches, such as may result from local vasculopathy, with no clinical or laboratory evidence of lupus anticoagulant or anticardiolipin antibody. Cardiac embolus from covert Libman-Sacks endocarditis remains less likely due to distribution.

More on Systemic Lupus Erythematosus

Overview: Systemic Lupus Erythematosus
Differential Diagnoses & Workup: Systemic Lupus Erythematosus
Treatment & Medication: Systemic Lupus Erythematosus
Follow-up: Systemic Lupus Erythematosus
Multimedia: Systemic Lupus Erythematosus
References
[ CLOSE WINDOW ]

References

  1. Ishimori ML, Pressman BD, Wallace DJ, Weisman MH. Posterior reversible encephalopathy syndrome: another manifestation of CNS SLE?. Lupus. 2007;16(6):436-43. [Medline].

  2. Mikdashi J, Krumholz A, Handwerger B. Factors at diagnosis predict subsequent occurrence of seizures in systemic lupus erythematosus. Neurology. Jun 28 2005;64(12):2102-7. [Medline].

  3. Joseph FG, Lammie GA, Scolding NJ. CNS lupus: a study of 41 patients. Neurology. Aug 14 2007;69(7):644-54. [Medline].

  4. Keane JR. Eye movement abnormalities in systemic lupus erythematosus. Arch Neurol. Dec 1995;52(12):1145-9. [Medline].

  5. Lee JH, Sung IY, Park JH, Roh JL. Recurrent laryngeal neuropathy in a systemic lupus erythematosus (SLE) patient. Am J Phys Med Rehabil. Jan 2008;87(1):68-70. [Medline].

  6. Sanna G, Bertolaccini ML, Cuadrado MJ, Laing H, Khamashta MA, Mathieu A, et al. Neuropsychiatric manifestations in systemic lupus erythematosus: prevalence and association with antiphospholipid antibodies. J Rheumatol. May 2003;30(5):985-92. [Medline].

  7. Ellis SG, Verity MA. Central nervous system involvement in systemic lupus erythematosus: a review of neuropathologic findings in 57 cases, 1955--1977. Semin Arthritis Rheum. Feb 1979;8(3):212-21. [Medline].

  8. Merkel PA, Chang Y, Pierangeli SS, et al. The prevalence and clinical associations of anticardiolipin antibodies in a large inception cohort of patients with connective tissue diseases. Am J Med. Dec 1996;101(6):576-83. [Medline].

  9. Choojitarom K, Verasertniyom O, Totemchokchyakarn K, et al. Lupus nephritis and Raynaud's phenomenon are significant risk factors for vascular thrombosis in SLE patients with positive antiphospholipid antibodies. Clin Rheumatol. Mar 2008;27(3):345-51. [Medline].

  10. AlSaleh J, Jassim V, ElSayed M, et al. Clinical and immunological manifestations in 151 SLE patients living in Dubai. Lupus. 2008;17(1):62-6. [Medline].

  11. Zanardi VA, Magna LA, Costallat LT. Cerebral atrophy related to corticotherapy in systemic lupus erythematosus (SLE). Clin Rheumatol. 2001;20(4):245-50. [Medline].

  12. Castellino G, Padovan M, Bortoluzzi A, et al. Single photon emission computed tomography and magnetic resonance imaging evaluation in SLE patients with and without neuropsychiatric involvement. Rheumatology (Oxford). Mar 2008;47(3):319-23. [Medline].

  13. Valdés-Ferrer SI, Vega F, Cantú-Brito C, et al. Cerebral changes in SLE with or without antiphospholipid syndrome. a case-control MRI study. J Neuroimaging. Jan 2008;18(1):62-5. [Medline].

  14. Glanz BI, Laoprasert P, Schur PH, et al. Lateralized EEG findings in patients with neuropsychiatric manifestations of systemic lupus erythematosus. Clin Electroencephalogr. Jan 2001;32(1):14-9. [Medline].

  15. Coles A. Looks like multiple sclerosis, but the ANA is positive: does my patient have lupus?. Pract Neurol. 2004;4(4):212-221.

  16. Trevisani VF, Castro AA, Neves Neto JF, Atallah AN. Cyclophosphamide versus methylprednisolone for the treatment of neuropsychiatric involvement in systemic lupus erythematosus. Cochrane Database Syst Rev. 2000;CD002265. [Medline].

  17. Ermann J, Bermas BL. The biology behind the new therapies for SLE. Int J Clin Pract. Dec 2007;61(12):2113-9. [Medline].

  18. Jónsdóttir T, Gunnarsson I, Risselada A, et al. Treatment of refractory SLE with rituximab plus cyclophosphamide: clinical effects, serological changes, and predictors of response. Ann Rheum Dis. Mar 2008;67(3):330-4. [Medline].

  19. Weinshenker BG, O'Brien PC, Petterson TM, et al. A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann Neurol. Dec 1999;46(6):878-86. [Medline].

  20. Crowther MA, Ginsberg JS, Julian J, et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome. N Engl J Med. Sep 18 2003;349(12):1133-8. [Medline].

  21. Wallace DJ. Improving the prognosis of SLE without prescribing lupus drugs and the primary care paradox. Lupus. 2008;17(2):91-2. [Medline].

  22. Phadungkiatwattana P, Sirivatanapa P, Tongsong T. Outcomes of pregnancies complicated by systemic lupus erythematosus (SLE). J Med Assoc Thai. Oct 2007;90(10):1981-5. [Medline].

  23. Brooks WM, Sabet A, Sibbitt WL, et al. Neurochemistry of brain lesions determined by spectroscopic imaging in systemic lupus erythematosus. J Rheumatol. Dec 1997;24(12):2323-9. [Medline].

  24. Bruyn GA. Controversies in lupus: nervous system involvement. Ann Rheum Dis. Mar 1995;54(3):159-67. [Medline].

  25. Calabrese LV, Stern TA. Neuropsychiatric manifestations of systemic lupus erythematosus. Psychosomatics. Jul-Aug 1995;36(4):344-59. [Medline].

  26. Futrell N. Inflammatory vascular disorders: diagnosis and treatment in ischemic stroke. Curr Opin Neurol. Feb 1995;8(1):55-61. [Medline].

  27. Futrell N, Schultz LR, Millikan C. Central nervous system disease in patients with systemic lupus erythematosus. Neurology. Sep 1992;42(9):1649-57. [Medline].

  28. Garton MJ, Isenberg DA. Clinical features of lupus myositis versus idiopathic myositis: a review of 30 cases. Br J Rheumatol. Oct 1997;36(10):1067-74. [Medline].

  29. Hess DC. Cerebral lupus vasculopathy. Mechanisms and clinical relevance. Ann N Y Acad Sci. Aug 14 1997;823:154-68. [Medline].

  30. Isshi K, Hirohata S. Differential roles of the anti-ribosomal P antibody and antineuronal antibody in the pathogenesis of central nervous system involvement in systemic lupus erythematosus. Arthritis Rheum. Oct 1998;41(10):1819-27. [Medline].

  31. Kourbeti IS, Boumpas DT. Biological therapies of autoimmune diseases. Curr Drug Targets Inflamm Allergy. Feb 2005;4(1):41-6. [Medline].

  32. Roldan CA, Shively BK, Crawford MH. An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus. N Engl J Med. Nov 7 1996;335(19):1424-30. [Medline].

  33. Steinlin MI, Blaser SI, Gilday DL, et al. Neurologic manifestations of pediatric systemic lupus erythematosus. Pediatr Neurol. Oct 1995;13(3):191-7. [Medline].

  34. Tan EM, Feltkamp TE, Smolen JS, et al. Range of antinuclear antibodies in "healthy" individuals. Arthritis Rheum. Sep 1997;40(9):1601-11. [Medline].

  35. Uramoto KM, Michet CJ, Thumboo J, et al. Trends in the incidence and mortality of systemic lupus erythematosus, 1950-1992. Arthritis Rheum. Jan 1999;42(1):46-50. [Medline].

  36. West SG, Emlen W, Wener MH, Kotzin BL. Neuropsychiatric lupus erythematosus: a 10-year prospective study on the value of diagnostic tests. Am J Med. Aug 1995;99(2):153-63. [Medline].

  37. Williams R, Harmon ME, Burlingame R, Du Clos T. Studies of serum C-reactive protein in systemic lupus erythematosus. J Rheumatol. Mar 2005;32(3):454-61. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

SLE, lupus, systemic lupus erythematosus, connective tissue disorder, CNS lupus, autoimmunity

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Tarakad S Ramachandran, MBBS, FRCP(C), FACP, Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital
Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine
Disclosure: Abbott Labs  Honoraria Consulting; Teva Marion Honoraria Consulting; Boeringer-Ingelheim Honoraria Speaking and teaching

Coauthor(s)

James Santiago Grisolia, MD, Active Staff, Scripps Mercy Hospital
James Santiago Grisolia, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Medical Association, and California Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Thomas A Kent, MD, Professor, Department of Neurology, Baylor College of Medicine; Neurology Care Line Executive, Michael E DeBakey Veterans Affairs Medical Center
Thomas A Kent, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, New York Academy of Sciences, Royal Society of Medicine, Sigma Xi, and Stroke Council of the American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Michael K Racke, MD, Professor, Neurology and Molecular Virology, Immunology, Medical Genetics; Chairman of Neurology; Chief, Neurology Service, Ohio State University Medical Center
Michael K Racke, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association for the Advancement of Science, American Association of Immunologists, and American Neurological Association
Disclosure: Teva Neuroscience Consulting fee Consulting; Peptimmune Inc. Consulting fee Consulting; Bristol Myers Squibb Consulting fee Consulting; EMD Serono Honoraria Speaking and teaching

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.