Hippocampal atrophy in systemic lupus erythematosus

Abstract

Objectives: To determine the frequency and progression of hippocampal atrophy in systemic lupus erythematosus (SLE) and the clinical, laboratory and treatment features associated with its occurrence. Methods: 150 patients with SLE and 40 healthy volunteers were enrolled in our study. A complete clinical, laboratory and neurological evaluation was performed. Magnetic resonance imaging was carried out using a 2T scanner (Elscint Prestige) and coronal T1-weighted images were used for manual volumetric measurements. Atrophy was defined as values ,2 standard deviations from the means of controls. Results: At entry into the study, the mean right and left hippocampal volumes of patients were significantly smaller than the hippocampal volumes of controls (p,0.001). After the follow-up magnetic resonance imaging, a significant progression of reduction in right and left hippocampal volumes in patients was observed (p,0.001). At entry, atrophy was identified in 43.9% and at follow-up in 66.7% of patients with SLE. Hippocampal atrophy was related to disease duration (p,0.001) total corticosteroid dose (p = 0.01) and history of central nervous system (CNS) manifestations (p = 0.01). Progression of atrophy was associated with cumulative corticosteroid dose (p = 0.01) and number of CNS events (p = 0.01). Patients with cognitive impairment had more severe hippocampal atrophy than those without. Conclusion: Disease duration, total corticosteroid dose and greater number of CNS manifestations were associated with hippocampal atrophy in patients with SLE. A significant progression of hippocampal atrophy related to total corticosteroid dose and number of CNS events was observed. Further studies are necessary to confirm these findings.

Magnetic Resonance Imaging in the Evaluation of Central Nervous System Manifestations in Systemic Lupus Erythematosus

“…Cortical and subcortical involvement seems to be driven by different factors, and even the rate of progression has been shown to be different in white and gray matter [9]. The impact of regional cerebral atrophy has also been studied, indicating that cognitive impairment may be present more frequently in both corpus callosum and hippocampal atrophy [9,18]. Mild or clinically insignificant spinal cord pathology has also been described in SLE, which might be secondary to Wallerian degeneration of long tract fibers passing through damaged areas of the brain [19].…”

Olfactory impairment in patients with the fibromyalgia syndrome and systemic sclerosis

“…The hippocampus, located in the temporal lobe, is a structure intimately associated with olfaction Several studies have shown that patients with SLE had significant hippocampal atrophy that correlated with disease duration, total corticosteroid dose and greater number of CNS manifestations [62]. In another study we have demonstrated that injection of anti-P ribosomal antibodies (anti-P) directly to the brain ventricles of mice induced depressive manifestations.…”

Non-Conventional MRI Techniques in Neurophychiatric Systemic Lupus Erythematosus (NPSLE): Emerging Tools to Elucidate the Pathophysiology and Aid the Diagnosis and Management

“…Selective involvement of the amygdala in patients with SLE and anti-NMDAR antibodies has been found . Cognitive impairment may be present more frequently in both corpus callosum and hippocampal atrophy (Appenzeller et al, 2006(Appenzeller et al, , 2008. Mild or clinically insignificant spinal cord pathology has also been described in SLE, which might be secondary to Wallerian degeneration of long tract fibers passing through damaged areas of the brain (Benedetti et al, 2007).…”