Markers of acute neuropsychiatric systemic lupus erythematosus: a multidisciplinary evaluation

Abstract

This study was aimed to assess: (1) the additive diagnostic utility of diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) over conventional MRI in detecting brain lesions in patients with acute primary neuropsychiatric systemic lupus erythematosus (NPSLE), and (2) the relevance of their findings to the associated NP manifestations. Included were 34 patients with acute NPSLE with mean age of 33.26 ± 10.14 years and duration of illness of 3.33 ± 1.71 years. Clinical interviewing and psychiatric and cognitive evaluations were performed by applying the criteria of the diagnostic and statistical manual of mental health disorders criteria (DSM-IV), Stanford Binet Subset Testing, Mini-Mental State Examination and Wechsler Memory Scale-Revised. Serologic tests included looking for antinuclear antibodies, anti-double strand DNA, anti-phospholipid antibodies. Radiologic evaluation included conventional MRI, DWI and MRA. One or more NP manifestations were diagnosed in 28 patients, in which cognitive deficits were reported with headache, psychosis and CVS. Anti-phospholipid antibodies were reported in patients with CVS. Twenty patients (71.43 %) with primary NPSLE (n = 28) had MRI abnormalities in which hyperintense signals at subcortical and periventricular white matter and at the junction between the gray and white matter represented 75 % (n = 15) and with headache (n = 6), psychosis (n = 6) and acute confusional state (n = 3) with and without cognitive deficits, respectively. Moderate-sized infarctions with restricted diffusion in the distribution of middle cerebral arteries were represented in 35 % (n = 7) and with CVS, of them, 71.43 % (n = 5) had beading and focal narrowing of carotid arteries were consistent with vasculitis. Brain atrophy represented 20 % (n = 4) and with psychosis. Compared to those with normal MRI, patients with MRI abnormalities were older (P < 0.050) and had longer duration of illness (P < 0.050). To conclude, although DWI and MRA are helping in more precise etiopathologic diagnosis compared to conventional MRI, but their relevance to the present NP manifestations is still limited.

Headache in patients with systemic lupus erythematosus: characteristics, brain MRI patterns, and impact

“…In our study, MRI abnormalities have been shown to be associated with cumulative organ damage in line with other studies that have found an association between the cumulative damage of SLE and the time of disease progression with white matter lesions [43,44]. Abda et al [45] demonstrated MRI abnormalities in older NPSLE patients with longer disease duration. Additional associations have been reported between WMH and cognitive dysfunction [39,43,46], cerebrovascular disease [43], low complement (CH50) level [39], and aPL antibodies [46].…”

Cognitive dysfunction and associated neuroimaging biomarkers in antiphospholipid syndrome: a systematic review

“…More than half of the included studies were cohort studies and n = 9 were case–control ( n = 2 APS/aPL positive, n = 3 SLE, n = 4 NPSLE) [ 20–29 ]. Three studies were longitudinal in design [ 30 , 31 , 23 ] and at least seven studies were reported as retrospective where patient cohorts and data were extracted from case notes and patient-held registries [ 32 , 33 , 34 , 35 , 36 , 27 , 28 ]. Cohort sizes within studies were generally small with the exception of the two most recent included studies [ 30 , 37 ], with mean age ranging from 31 to 81 years, and >75% were female.…”

“…The remaining other 13 studies included patients with aPL positivity and only one of these studies [ 25 ] reported that the presence of aPL was recorded at least twice over 12 weeks apart, whereas all other studies [ 30 , 37 , 33 , 34 , 39 , 40 , 36 , 23 , 24 , 26 , 27 , 29 ] recorded the presence of aPL following a single sample and did not specify that aPL was retested to confirm persistence. A small number of studies included all three criteria aPL (LA; IgG and IgM aCL; and anti-β2GPI) [ 32 , 20–22 , 24 , 25 ], with the combination aCL and LA as the most common included antibodies [ 38 , 34 , 35 , 36 , 28 , 29 ] or aCL as the only included aPL [ 37 , 33 , 31 , 26 , 27 ]. Only five studies indicated their cut-off values for aPL [ 32 , 33 , 37 , 38 , 24 ], with two of these studies using the Sapporo/Sydney laboratory criteria [ 38 , 32 ].…”

From Systemic Inflammation to Neuroinflammation: The Case of Neurolupus

“…Today, several advanced imaging modalities exist. These include diffusion-weighted imaging (DWI) [ 105 ], magnetic transfer imaging (MTI) [ 106 ], magnetic resonance angiography (MRA) [ 107 ], magnetic resonance spectroscopy (MRS) [ 108 ], diffusion tensor imaging (DTI) [ 109 ], and blood oxygen level-dependent functional MRI (BOLD-fMRI) [ 93 ], and they ideally could be implemented for identifying functional hallmarks of NPSLE and allow its diagnosis [ 11 , 110 ]. These methods are not detailed here, as this review rather focuses on data obtained in preclinical research performed on murine NPSLE models.…”