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Markers of acute neuropsychiatric systemic lupus erythematosus: a multidisciplinary evaluation

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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.

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Abbreviations

SLE:

Systemic lupus erythematosus

NP:

Neuropsychiatric

NPSLE:

Neuropsychiatric systemic lupus erythematosus

CNS:

Central nervous system

CVS:

Cerebrovascular stroke

MRI:

Magnetic resonance imaging

T1WI:

T1-weighted imaging

FLAIR:

Fluid attenuation recovery-weighted images

DWI:

Diffusion-weighted imaging

MRA:

Magnetic resonance angiography

DSM–IV:

Diagnostic and statistical manual of mental health disorders 4th (edition)

SBST, 4th edition:

Stanford Binet subsets testing (4th edition)

MMSE:

Mini-mental state examination

WMS-R:

Wechsler memory scale-revised

SLEDAI:

Systemic lupus erythematosus disease activity index

ANA:

Antinuclear antibodies

a-dsDNA-a:

Antibodies to double-stranded DNA

aPL-a:

Anti-phospholipid antibodies

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Conflict of interest

We declare that this work has no conflict of interests. There is no involvement of sponsor for this work design, data collection, analysis, interpretation, drafting nor the decision to submit this paper for publication. All are authors’ responsibility.

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Authors and Affiliations

  1. Department of Rheumatology and Rehabilitation, Assiut University Hospital, Assiut, Egypt

    Essam A. Abda

  2. Sohag Faculty of Medicine, South Valley University, Sohag, Egypt

    Zahraa I. Selim

  3. Department of Radiology, Assiut University Hospital, Assiut, Egypt

    Moustafa E. M. Radwan & Nagham M. Mahmoud

  4. Department of Internal Medicine, Assiut University Hospital, Assiut, Egypt

    Omar M. Herdan

  5. Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, P.O. Box 71516, Assiut, Egypt

    Khalid A. Mohamad & Sherifa A. Hamed

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  1. Essam A. Abda
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  2. Zahraa I. Selim
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  3. Moustafa E. M. Radwan
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  4. Nagham M. Mahmoud
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Correspondence to Sherifa A. Hamed.

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Abda, E.A., Selim, Z.I., Radwan, M.E.M. et al. Markers of acute neuropsychiatric systemic lupus erythematosus: a multidisciplinary evaluation. Rheumatol Int 33, 1243–1253 (2013). https://doi.org/10.1007/s00296-012-2531-0

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