Microembolic signals in systemic lupus erythematosus and other cerebral small vessel diseases

Abstract

Microembolic signals (MES) are detected by transcranial Doppler (TCD), and are mainly observed in cardiac and large-artery diseases; however they might also be observed in conditions affecting small vessels of the brain. We aimed to review the current medical literature related to MES assessed by TCD in patients with cerebral small vessel disease. We conducted a systematic review in PubMed and selected the articles with information on this topic. Systemic lupus erythematosus (SLE) is the disease with more articles; pooled data showed a frequency of MES of 14.9%. MES were more frequent in SLE patients with antiphospholipid antibodies and ischemic stroke. MES have also been described in other diseases such as primary antiphospholipid syndrome, Sneddon's syndrome, and Behçet's disease. Further studies assessing the significance of MES in the pathogenesis of neurological manifestations of these disorders is warranted.

Subclinical cerebrovascular cognitive function, and mood changes in patients with systemic  lupus erythematosus

“…TCD is a sensitive, real-time monitor of cerebral blood flow velocity (CBFV) and emboli. 9 The present study was conducted to clarify issues regarding 1) the prevalence of neuropsychiatric disorders in a randomly selected group of SLE patients with or without manifest neuropsychiatric symptoms, 2) the early appearance of cerebrovascular changes in SLE patients by usage of transcranial duplex imaging to assist internal cerebral blood vessels. In addition, to determine the relation between transcranial duplex findings of different intracranial vessels with systemic, neuropsychiatric symptoms cognitive function and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI).…”

Systemic Lupus Erythematosus Patients with and without Neuropsychiatric Manifestations: A Neck and Transcranial Duplex Sonography Study

“…Interestingly, it was demonstrated that duplex sonography of intracranial vessels is able to individuate patients with microembolic causes of NPSLE (13,14); in our NPSLE group of patients, nobody had microembolic disease but other causes, all meeting the Hocheberg's modified ACR nomenclature (17), were implicated. This heterogeneity of causes might be a reason why ultrasound is not able to differentiate patients with NPSLE from the others without neuropsychiatric manifestations.…”

“…Little information is available on the role of ultrasound in evaluating carotid and cerebral arteries in SLE. The importance of transcranial Doppler sonography was interestingly shown by some studies that correlated the presence of microembolic signals with neuropsychiatric disorders in SLE (13,14). Therefore, our aim was to evaluate internal carotid and middle cerebral arteries by means of duplex sonography in healthy control subjects and in NPSLE compared to other SLE patients.…”

“…Transcranial Doppler (TCD) ultrasound was used to assess microembolic signals (MES) in SLE patients. MES have been found in about 10% of patients with SLE and have been associated with neuropsychiatric manifestations, including cerebrovascular damage (13,14).…”

Intravenous thrombolysis in Sneddon’s syndrome

“…Microembolic signals in medium-sized arteries have been described in SS patients. 6 Finally, the baseline CBV was relatively preserved, which may be associated with a favorable clinical response after treatment with rt-PA.…”