Cerebral Microembolism in Patients With Sneddon's Syndrome

Sitzer, Matthias; Söhngen, D; Siebler, Mario; Specker, Christof; Rademacher, J.; I, Janda; Aulich, A.; Steinmetz, Helmuth

doi:10.1001/archneur.1995.00540270063020

Cited by 40 publications

(35 citation statements)

References 28 publications

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“…We believe that cerebral microemboli may also be among the pathogenetic mechanisms. In other words, the presence of cerebral microemboli alone cannot explain the wide variety of neuropsychiatric syndromes; however, it might contribute to the complex etiopathogenesis of neuropsychiatric lupus [11, 12]. In previous studies, cerebral MES monitoring using long-term TCD has been proved to be predictive of past and future thromboembolic events in patients with artery-to-artery or cardiac embolism [6, 7].…”

Section: Discussionmentioning

confidence: 99%

Detection of Microembolic Signals in Patients with Neuropsychiatric Lupus erythematosus

Kumral

Evyapan²,

Keser³

et al. 2002

Eur Neurol

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The pathogenesis of central nervous system involvement in systemic lupus erythematosus (SLE) is not completely understood. In this study, we investigated the association of microembolic signals (MES) with a variety of neuropsychiatric SLE manifestations and compared our results with those from SLE patients without neuropsychiatric lupus and normal controls. Fifty-three patients with SLE (45 females and 8 males), all fulfilling the revised classification criteria for SLE, and 50 control subjects (44 females and 6 males) were enrolled in this study. All SLE patients were assessed by neuropsychological examination, including various neuropsychiatric tests. Twenty-five patients with SLE were found to have at least one of the neuropsychiatric syndromes defined by The American College of Rheumatology. The mean MES count in patients with neuropsychiatric lupus was significantly higher than those without (5.4 ± 1.1 vs. 0.3 ± 0.8/h; p < 0.005). We found a positive correlation between higher mean MES counts and the presence of neuropsychiatric syndromes in SLE. The mean MES count in the whole group of SLE patients was also significantly higher than that in healthy controls. The mean MES count of SLE patients with antiphospholipid (aPL) antibody positivity was significantly higher than those without aPL antibodies (3.6 ± 1.6 vs. 0.8 ± 0.1/h; p < 0.005). In conclusion, the association of MES with neuropsychiatric lupus may support the possible contribution of MES to the complex pathophysiology of this syndrome. More importantly, detection of MES on transcranial Doppler monitoring might suggest a high risk of involvement of the central nervous system in SLE, and could be used as a diagnostic tool.

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Section: Discussionmentioning

confidence: 99%

Detection of Microembolic Signals in Patients with Neuropsychiatric Lupus erythematosus

Kumral

Evyapan²,

Keser³

et al. 2002

Eur Neurol

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“…The audible TCD analog output signal of the 2 MHz pulsed-waved probe (Multidop, DWL, Sipplingen, Germany) was recorded digitally on tape for further offline analyses and blinded rating using interobserver based rating criteria. 7,8 …”

Section: Transcranial Doppler Ultrasoundmentioning

confidence: 99%

“…5,6 Finally, we used a non-invasive transcranial Doppler ultrasound examination to search for cellular aggregates as a marker of microembolism in the arterial circulation. 7,8 …”

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confidence: 99%

Analysis of rhG-CSF-effects on platelets by in vitro bleeding test and transcranial Doppler ultrasound examination

Söhngen

Wienen

Siebler

et al. 1998

Bone Marrow Transplant

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Summary:Experimental evidence suggests a stimulatory effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on both platelets and coagulation. RhG-CSF is increasingly used to stimulate healthy volunteer donors for blood stem cell mobilization. We therefore assessed 25 healthy donors receiving rhG-CSF for changes in in vitro bleeding test (IVBT), coagulation parameters and cerebral microembolism by transcranial Doppler (TCD) ultrasound. A significant shortening of IVBT was found on day 4 of rhG-CSF administration together with increased levels of fibrinogen and factor VIII and reduced activities of protein C and protein S. Although these changes are quite small it is possible that they may lead to a hypercoagulable state especially in donors with other risk factors for thromboembolism. However, TCD examination failed to detect any signs of microembolism. We therefore conclude that rhG-CSF leads to significant changes in coagulation parameters, but has no effect on TCD detectable microembolism as a stroke risk factor. However donors receiving rhG-CSF should be examined carefully to detect pre-existing changes in the coagulation system and we would like to suggest a routine thrombophilia screen. Keywords: in vitro bleeding test; blood coagulation; recombinant human granulocyte colony-stimulating factor; transcranial Doppler ultrasound In the context of autologous and allogeneic stem cell transplantation rhG-CSF is routinely used as a growth factor to mobilize peripheral blood stem cells. 1,2 In patients with normal bone marrow function this leads to a significant increase of peripheral leukocyte counts, so that rheological changes and disturbances of blood flow are to be anticipated. To date, we have noted thrombotic complications of central venous lines in two out of 20 patients under rhG-CSF administration. Moreover, in vitro tests demonstrated an activation of platelets and the coagulation system. 3,4 As a growing number of healthy donors receive rhG-CSF for stem cell mobilization in our institution, we were interested

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“…However, we did not include any cases with valve pathology in our study. Although MES have been reported in patients with aPL antibodies 16,18,28,29 , no association was found in Dahl's and Kron's studies 19,17 . In our study, plaque formation, and aPL antibodies were more frequent in the MES-Positive group, but these failed to reach statistical significance.…”

Section: Discussionmentioning

confidence: 95%

Microembolic Signals in Patients with Systemic Lupus Erythematosus

Azarpazhooh

Mokhber²,

Orouji

et al. 2010

Can. j. neurol. sci.

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Central nervous system involvement is one of the most serious complications of systemic lupus erythematosus (SLE). More than half of patients with SLE demonstrate major psychiatric and neurological disorders [1][2][3][4] . The most common manifestations of neuropsychiatric SLE (NP-SLE) include seizures, psychosis, brainstem dysfunction, stroke and cognitive impairment 2 . Despite the numerous previous studies [5][6][7][8] , the exact pathogenesis of disease is not completely understood, and therefore its recognition and treatment remains a major diagnostic and therapeutic challenge. The possible mechanisms include vasculopathy, autoantibody production, immunologically mediated thromboembolism and systemic inflammation. Antiphospholipid (aPL) antibodies, hyperhomocysteinaemia, cardiac valve pathology and other vascular risk factors can also increase the risk of stroke 4,9-14 .ABSTRACT: Introduction: Central nervous system (CNS) involvement is a common and less understood aspect of systemic lupus erythematosus (SLE). Microembolic signals (MES) have been reported in SLE. We conducted a prospective study to evaluate the frequency of MES among patients with CNS involvement and those without. The main aim of the study is to clarify the pathophysiology of the CNS involvement in SLE. Methods and Materials: Sixty eight patients with a diagnosis of SLE (60 females, 8 males) participated in the study. Both middle cerebral arteries were monitored using transcranial Doppler for 60 min to detect MES. All cases underwent neurology and psychiatry assessments. Results: MES were detected in 7/68 patients (10.3%) with the mean number of 3.5 per hour. MES were significantly higher in patients with CNS involvement (6/24, 25%) than those without (1/44, 2.2%) (P=0.006). SLE disease activity index, duration of disease, plaque formation, intima-media thickness, and antiphospholipid antibodies were not associated with MES. MES were more frequent in patients receiving Aspirin and/or Warfarin (p=0.02). Conclusions: MES may be a predictor for CNS involvement in SLE patients at risk for neuropsychiatric syndromes. Cerebral embolism may be implicated in the pathophysiology of neuropsychiatric SLE. RÉSUMÉ: Signaux microemboliques chez les patients atteints de lupus érythémateux aigu disséminé.Contexte : L'atteinte du système nerveux central (SNC) est fréquente dans le lupus érythémateux aigu disséminé (LEAD), mais cet aspect de la maladie est mal compris. Des signaux microemboliques (SME) ont été décrits dans le LEAD. Nous avons effectué une étude prospective pour évaluer la fréquence des SME chez les patients qui avaient une atteinte du SNC et chez ceux qui n'en avaient pas. Le but principal de l'étude était de déterminer la physiopathologie de l'atteinte du SNC dans le LEAD. Méthodes et matériels : Soixante-huit patients chez qui un diagnostic de LEAD avait été posé (60 femmes et 8 hommes) ont participé à l'étude. Les deux artères cérébrales moyennes ont été étudiées pendant 60 minutes au moyen du Doppler transcrânien afin de détecter les SM...

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Cerebral Microembolism in Patients With Sneddon's Syndrome

Cited by 40 publications

References 28 publications

Detection of Microembolic Signals in Patients with Neuropsychiatric Lupus erythematosus

Detection of Microembolic Signals in Patients with Neuropsychiatric Lupus erythematosus

Analysis of rhG-CSF-effects on platelets by in vitro bleeding test and transcranial Doppler ultrasound examination

Microembolic Signals in Patients with Systemic Lupus Erythematosus

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