Fatigue is associated with cerebral white matter hyperintensities in patients with systemic lupus erythematosus

Objective: The occurrence of ischemic stroke in patients with systemic lupus erythematosus (SLE) can cause extended periods of reduced daily activities. However, the risk factors for ischemic stroke in SLE patients are not fully elucidated. Herein, we examined the effect of white matter hyperintensities (WMH) on the occurrence of ischemic stroke in SLE patients.Methods: We analyzed the relationship between WMH burden and ischemic stroke using follow-up brain magnetic resonance imaging (MRI) data of 79 patients with SLE. Of these patients, 16 developed stroke during the observation period. WMH on MRI were classified into periventricular hyperintensities and deep white matter hyperintensities (DWMH), while the lesion extent was graded using the Fazekas scale.Results: Kaplan–Meier curves showed that ischemic stroke events were significantly associated with age at initial brain MRI of ≥40 years (p = 0.015) and history of anti-phospholipid syndrome (p = 0.030). Additionally, ischemic stroke events were significantly associated with a one grade deterioration of periventricular hyperintensities (p = 0.003) and a one grade deterioration of DWMH (p = 0.002). Multivariate analysis using the logistic regression model showed that a one grade deterioration of DWMH was an independent risk factor for ischemic stroke (hazard ratio, 6.0; 95% confidence interval, 1.3–27.4).Conclusions: Although several factors affect the occurrence of ischemic stroke, SLE patients show increased risk of ischemic stroke via development of DWMH. An observation of DWMH deterioration on follow-up brain MRI may be useful for assessing the risk of ischemic stroke in SLE patients.

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Different phenotypes of neuropsychiatric systemic lupus erythematosus are related to a distinct pattern of structural changes on brain MRI

European Radiology ◽

10.1007/s00330-021-07970-2 ◽

2021 ◽

Author(s):

Francesca Inglese ◽

Ilse M. J. Kant ◽

Rory C. Monahan ◽

Gerda M. Steup-Beekman ◽

Tom W. J. Huizinga ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

White Matter ◽

Lupus Erythematosus ◽

White Matter Hyperintensities ◽

Brain Mri ◽

Systemic Lupus ◽

Brain Volumes ◽

Total Brain ◽

Inflammatory Phenotype ◽

Structural Brain

Abstract Objectives The underlying structural brain correlates of neuropsychiatric involvement in systemic lupus erythematosus (NPSLE) remain unclear, thus hindering correct diagnosis. We compared brain tissue volumes between a clinically well-defined cohort of patients with NPSLE and SLE patients with neuropsychiatric syndromes not attributed to SLE (non-NPSLE). Within the NPSLE patients, we also examined differences between patients with two distinct disease phenotypes: ischemic and inflammatory. Methods In this prospective (May 2007 to April 2015) cohort study, we included 38 NPSLE patients (26 inflammatory and 12 ischemic) and 117 non-NPSLE patients. All patients underwent a 3-T brain MRI scan that was used to automatically determine white matter, grey matter, white matter hyperintensities (WMH) and total brain volumes. Group differences in brain tissue volumes were studied with linear regression analyses corrected for age, gender, and total intracranial volume and expressed as B values and 95% confidence intervals. Results NPSLE patients showed higher WMH volume compared to non-NPSLE patients (p = 0.004). NPSLE inflammatory patients showed lower total brain (p = 0.014) and white matter volumes (p = 0.020), and higher WMH volume (p = 0.002) compared to non-NPSLE patients. Additionally, NPSLE inflammatory patients showed lower white matter (p = 0.020) and total brain volumes (p = 0.038) compared to NPSLE ischemic patients. Conclusion We showed that different phenotypes of NPSLE were related to distinct patterns of underlying structural brain MRI changes. Especially the inflammatory phenotype of NPSLE was associated with the most pronounced brain volume changes, which might facilitate the diagnostic process in SLE patients with neuropsychiatric symptoms. Key Points • Neuropsychiatric systemic lupus erythematosus (NPSLE) patients showed a higher WMH volume compared to SLE patients with neuropsychiatric syndromes not attributed to SLE (non-NPSLE). • NPSLE patients with inflammatory phenotype showed a lower total brain and white matter volume, and a higher volume of white matter hyperintensities, compared to non-NPSLE patients. • NPSLE patients with inflammatory phenotype showed lower white matter and total brain volumes compared to NPSLE patients with ischemic phenotype.

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MR Diffusion Tractography to Identify and Characterize Microstructural White Matter Tract Changes in Systemic Lupus Erythematosus Patients

Academic Radiology ◽

10.1016/j.acra.2016.03.019 ◽

2016 ◽

Vol 23 (11) ◽

pp. 1431-1440 ◽

Cited By ~ 8

Author(s):

RaviK. Shastri ◽

GaurangV. Shah ◽

Page Wang ◽

Patricia Cagnoli ◽

Tobias Schmidt-Wilcke ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

White Matter ◽

Lupus Erythematosus ◽

White Matter Tract ◽

Systemic Lupus ◽

Diffusion Tractography ◽

Mr Diffusion

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Neurometabolic changes in normal white matter may predict appearance of hyperintense lesions in systemic lupus erythematosus

Lupus ◽

10.1177/0961203307084723 ◽

2007 ◽

Vol 16 (12) ◽

pp. 963-971 ◽

Cited By ~ 32

Author(s):

S. Appenzeller ◽

L.M. Li ◽

L.T.L. Costallat ◽

F. Cendes

Keyword(s):

Systemic Lupus Erythematosus ◽

White Matter ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Normal White Matter

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Jaw Dystonia and Reversible Basal Ganglia Changes as an Initial Presentation of Systemic Lupus Erythematosus

The Neurohospitalist ◽

10.1177/1941874417698323 ◽

2017 ◽

Vol 8 (1) ◽

pp. 31-34 ◽

Cited By ~ 2

Author(s):

Meghan Romba ◽

Yujie Wang ◽

Shu-Ching Hu ◽

Sandeep Khot

Keyword(s):

Systemic Lupus Erythematosus ◽

White Matter ◽

Basal Ganglia ◽

Brain Imaging ◽

Lupus Erythematosus ◽

Subcortical White Matter ◽

High Dose ◽

Neuropsychiatric Lupus ◽

Systemic Lupus ◽

Traditional Treatment

Dystonia as a manifestation of neuropsychiatric lupus erythematosus (NPSLE) is uncommon. We report a 25-year-old woman who experienced progressive confusion, reduced speech, and difficulty opening her mouth approximately 2 weeks after development of a facial rash. Brain imaging showed bilateral, symmetric signal abnormalities within the basal ganglia and subcortical white matter. Despite treatment with high-dose steroids, she continued to have difficulty speaking with evidence of jaw dystonia on examination. Jaw dystonia rapidly improved with the initiation of levodopa. Repeat evaluation 3 months later exhibited the absence of jaw dystonia and near resolution of the imaging abnormalities. Our patient demonstrated a unique presentation with jaw dystonia refractory to traditional treatment for NPSLE. Such a presentation likely represents a severe variant of NPSLE requiring both immunosuppressive and symptomatic therapies.

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