Neuropsychiatric lupus and reversible posterior leucoencephalopathy syndrome: a challenging clinical dilemma

Mak, Anselm; Chan, Bernard P.L.; Yeh, Ing Berne; Ho, Roger; Ml, Boey; Feng, Ping; Koh, Dow Rhoon; Ong, Benjamin

doi:10.1093/rheumatology/kem319

Cited by 53 publications

(57 citation statements)

References 53 publications

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“…Some authors suggest PRES is best considered a secondary complication of SLE or its treatment rather than SLE as a direct cause (4). Given the combined features of neurological symptoms and typical imaging findings in this entity, Mak et al proposed an algorithm for the diagnosis of this condition (5). In a review of 17 SLE cases with PRES, they concluded that urgent brain MRI and initiation of immediate treatment for PRES with very tight blood pressure control and antiepileptic medication are the mainstay of management.…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome in Class IV Lupus Nephritis – Case report and brief review of literature

2018

IJCR

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Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome in Class IV Lupus Nephritis – Case report and brief review of literature

2018

IJCR

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“…8,14 Un 20%-95% de pacientes con LES tienen manifestaciones neurológicas agrupadas bajo la denominación de lupus neuropsiquiátrico (LNPS) y pueden ser la forma de presentación del LES con escasos síntomas sistémicos. 6,15 Las manifestaciones clínicas son similares a la EPR y, por lo tanto, difíciles de diferenciar. Se recomienda el uso de la resonancia magnética para llegar a un diagnóstico de certeza y planear el tratamiento correspondiente.…”

Section: Discussionunclassified

“…Se recomienda el uso de la resonancia magnética para llegar a un diagnóstico de certeza y planear el tratamiento correspondiente. 1,15 Los diagnósticos diferenciales más importantes incluyen accidente cerebrovascular, trombosis de senos venosos y meningoencefalitis aséptica e infecciosa, 1 descartados en nuestra paciente sobre la base de la radiología y los análisis de laboratorio. Se desestimó tuberculosis cerebral por estos métodos diagnósticos y la evolución clínica.…”

Section: Discussionunclassified

Encefalopatía reversible posterior en una niña con lupus eritematoso sistémico. Presentación de un caso

Marín¹

2015

Arch Argent Pediat

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Arch Argent Pediatr 2015;113(5):e271-e274 / e271Presentación de casos clínicos RESUMEN La encefalopatía posterior reversible es una patología de baja frecuencia en pediatría. Las manifestaciones clínicas características son cefaleas, convulsiones, trastornos visuales y de conciencia asociadas a imágenes típicas en la resonancia magnética del sistema nervioso. Por lo general, se manifiesta en pacientes con eclampsia, trasplante de órganos sólidos, enfermedades hematológicas, renales y autoinmunes, entre otras causas menos frecuentes, y suele desencadenarse luego de un cuadro de hipertensión arterial o el uso de drogas inmunosupresoras. Factores patogénicos menos habituales, como transfusión sanguínea, uso de inmunoglobulinas o una infección subyacente, pueden estar asociados. Se describe una paciente con lupus eritematoso sistémico, que desarrolló la encefalopatía al estar expuesta a múltiples factores etiopatogénicos. Palabras clave: síndrome de encefalopatía posterior reversible, lupus eritematoso sistémico, pediatría. ABSTRACTPosterior reversible encephalopathy is a rare disease in children. Clinical manifestations include headache, seizures, visual disturbances and altered consciousness associated with typical magnetic resonance images of the nervous system. The syndrome usually manifests in patients with eclampsia, solid organ transplantation, haematologic, renal and autoimmune diseases among other less common causes and it is often triggered after a hypertensive crisis or use of immunosuppressive drugs. Less common pathogenic factors as blood transfusion, use of immunoglobulins or an underlying infection can be associated. In this case a girl with systemic lupus erythematosus and exposed to multiple etiopathogenic factors developed posterior reversible encephalopathy.

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“…It can occur as a result of conditions such as eclampsia, hypertensive encephalopathy, and intense immunosuppression [168]. Patients with SLE and systemic vasculitis s have been reported to present with PRES [169], and a distinction between 2 subtypes of PRES in SLE, inflammatory and hypertensive, has been proposed [170].…”

Section: Posterior Reversible Encephalopathy Syndromementioning

confidence: 99%

“…Often, escalation of immunosuppression can aggravate symptoms instead of resolving them [171]. However, in patients with SLE with high disease activity, a reduction of immunosuppression is usually not advocated, as the participation of inflammatory mechanisms is highly likely [168,172].…”

Section: Posterior Reversible Encephalopathy Syndromementioning

confidence: 99%

Immunotherapies for Neurological Manifestations in the Context of Systemic Autoimmunity

et al. 2016

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Neurological involvement is relatively common in the majority of systemic autoimmune diseases and may lead to severe morbidity and mortality, if not promptly treated. Treatment options vary greatly, depending on the underlying systemic pathophysiology and the associated neurological symptoms. Selecting the appropriate therapeutic scheme is further complicated by the lack of definite therapeutic guidelines, the necessity to differentiate primary neurological syndromes from those related to the underlying systemic disease, and to sort out adverse neurological manifestations caused by immunosuppressants or the biological agents used to treat the primary disease. Immunotherapy is a sine qua non for treating most, if not all, neurological conditions presenting in the context of systemic autoimmunity. Specific agents include classical immune modulators such as corticosteroids, cyclophosphamide, intravenous immunoglobulin, and plasma exchange, as well as numerous biological therapies, for example antitumor necrosis factor agents and monoclonal antibodies that target various immune pathways such as B cells, cytokines, and co-stimulatory molecules. However, experience regarding the use of these agents in neurological complications of systemic diseases is mainly empirical or based on small uncontrolled studies and case series. The aim of this review is to present the state-of-the-art therapies applied in various neurological manifestations encountered in the context of systemic autoimmune diseases; evaluate all treatment options on the basis of existing guidelines; and compliment these data with our personal experience derived from a large number of patients.

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Neuropsychiatric lupus and reversible posterior leucoencephalopathy syndrome: a challenging clinical dilemma

Cited by 53 publications

References 53 publications

Posterior Reversible Encephalopathy Syndrome in Class IV Lupus Nephritis – Case report and brief review of literature

Posterior Reversible Encephalopathy Syndrome in Class IV Lupus Nephritis – Case report and brief review of literature

Encefalopatía reversible posterior en una niña con lupus eritematoso sistémico. Presentación de un caso

Immunotherapies for Neurological Manifestations in the Context of Systemic Autoimmunity

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