Elevated Cerebral Blood Flow and Volume in Systemic Lupus Measured by Dynamic Susceptibility Contrast Magnetic Resonance Imaging

Gasparovic, Charles; Roldan, Carlos A.; Sibbitt, Wilmer L.; Qualls, Clifford; Mullins, Paul G.; Sharrar, Janeen; Yamamoto, Junkoh; Bockholt, H. Jeremy

doi:10.3899/jrheum.091276

Cited by 26 publications

(35 citation statements)

References 39 publications

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“…The two groups were similar in all demographic variables (Table 1). More extensive clinical data and findings on this cohort can be found in Table 2 and in a previous report (11). …”

Section: Methodsmentioning

confidence: 76%

“…The vast majority of the latter studies measured relative CBF with single photon emission computed tomography (SPECT) and found that CBF was lower in focal or broad regions of the brain with respect to a region presumed to be normal within the SLE subjects (4–10). However, it has recently been demonstrated using dynamic susceptibility contrast MRI (DSC-MRI) that both CBF and cerebral blood volume (CBV) may be higher in normal appearing brain tissue in SLE patients than healthy controls (11). Elevated CBF has also been observed in other neurological disorders, including epilepsy (12), stroke (13), transient ischemic attack (14), fibromyalgia (15), metabolic brain disease (16), and migraine (17).…”

Section: Introductionmentioning

confidence: 99%

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Blood Pressure and Vascular Dysfunction Underlie Elevated Cerebral Blood Flow in Systemic Lupus Erythematosus

Gasparovic¹,

Qualls²,

Greene³

et al. 2012

J Rheumatol

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Objective In previous studies, cerebral blood flow (CBF) has been found to be altered in patients with systemic lupus erythematosus (SLE) compared to controls. In the present study, the relationships between CBF and clinical data from SLE subjects were explored with the aim of determining the pathologic factors underlying altered CBF in SLE. Methods 42 SLE subjects and 19 age and gender matched normal control subjects were studied. Dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) was used to measure CBF. Patients and controls underwent complete clinical and laboratory evaluations in close proximity with their MRI studies. Results A higher CBF was present in the SLE group and was independently associated in statistical models with higher systolic blood pressure (sBP) (p<0.01). However, the intensity of the relationship (slope of curve) between CBF and mean arterial blood pressure (MAP), diastolic blood pressure (dBP), or blood levels of tissue plasminogen activator (tPA) in the SLE group were significantly blunted relative to the healthy control group. Conclusion These findings are consistent with an underlying cerebral hyperperfusion in SLE induced by elevated but non-hypertensive levels of systolic blood pressure. The factors underlying this relationship may be functional and/or structural (atherosclerotic, thrombotic, thromboembolic, or vasculitic) cerebrovascular disease.

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“…The two groups were similar in all demographic variables (Table 1). More extensive clinical data and findings on this cohort can be found in Table 2 and in a previous report (11). …”

Section: Methodsmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Blood Pressure and Vascular Dysfunction Underlie Elevated Cerebral Blood Flow in Systemic Lupus Erythematosus

Gasparovic¹,

Qualls²,

Greene³

et al. 2012

J Rheumatol

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“…Dynamic susceptibility contrast MRI was performed in 89 (92%) participants (64 patients, 25 controls) to assess brain perfusion (24). Brain lesions were classified as old or recent cerebral infarcts and small focal periventricular or deep white abnormalities using standard criteria (3,4,10).…”

Section: Methodsmentioning

confidence: 99%

Libman-Sacks Endocarditis and Embolic Cerebrovascular Disease

Roldan

Sibbitt

Qualls

et al. 2013

JACC: Cardiovascular Imaging

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Objective To determine whether Libman-Sacks endocarditis is a pathogenic factor for cerebrovascular disease (CVD) in systemic lupus erythematosus (SLE). Background A cardioembolic pathogenesis of SLE CVD manifested as 1) neuropsychiatric SLE (NPSLE) including stroke and transient ischemic attacks (TIA), 2) neurocognitive dysfunction, and 3) MRI focal brain lesions has not been established. Methods A 6-year study of 30 patients with acute NPSLE (27 women, age 38±12 years), 46 age-and-sex matched SLE controls without NPSLE (42 women, age 36±12 years), and 26 age-and-sex matched healthy controls (22 women, age 34±11 years) who underwent clinical and laboratory evaluations, TEE, carotid duplex, transcranial Doppler, neurocognitive testing, and brain MRI/MRA. NPSLE patients were re-evaluated after 4.5 months of therapy. All patients were followed clinically for a median of 52 months. Results Libman-Sacks vegetations (87%), cerebromicroembolism (27% with 2.5 times more events per hour), neurocognitive dysfunction (60%), and cerebral infarcts (47%) were more common in NPSLE than in SLE (28%, 20%, 33%, and 0%) and healthy controls (8%, 0%, 4%, and 0%, respectively) (all p≤0.009). Patients with vegetations had 3 times more cerebromicroemboli per hour, lower cerebral blood flow, more stroke/TIA and overall NPSLE events, neurocognitive dysfunction, cerebral infarcts, and brain lesion load than those without (all p≤0.01). Libman-Sacks vegetations were independent risk factors of NPSLE (OR=13.4, p<0.001), neurocognitive dysfunction (OR=8.0, p=0.01), brain lesions (OR=5.6, p=0.004), and all 3 outcomes combined (OR=7.5, p<0.001). Follow-up re-evaluations in 18 (78%) of 23 surviving NPSLE patients demonstrated improvement of vegetations, microembolism, brain perfusion, neurocognitive dysfunction, and lesion load (all p≤0.04). Finally, patients with vegetations had reduced event free survival time to stroke/TIA, cognitive disability, or death (p=0.007). Conclusion The presence of Libman-Sacks endocarditis in patients with SLE is associated with higher risk for embolic CVD. This suggests that Libman-Sacks endocarditis may be a source of cerebral emboli.

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“…SLEDAI is a reliable and valid instrument for measuring the clinical state in patients with SLE 37. In this study, significant negative Pearson correlations were found between SLEDAI, MCA PI, PCA PI, and some cognitive function tests such as short-term memory, drawing, and fluency.…”

Section: Discussionmentioning

confidence: 57%

Multimodal neurophysiological and psychometric evaluation among patients with systemic lupus erythematosus

Shehata¹,

Elserogy²,

Ahmad³

et al. 2011

IJGM

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Objective:To determine some of the neuropsychiatric manifestations of systemic lupus erythematosus (SLE) by applying multimodal neurophysiological and psychometric studies.Patients and methods:Twenty-six SLE patients were evaluated for neurological and psychiatric disorders and compared with 26 healthy controls matched for age, sex, education, and social class. The severity of SLE disease was assessed. Each subject was subjected to the following examinations: laboratory, neurophysiology, magnetic resonance imaging of the brain, transcranial duplex, Modified Mini-mental State Examination, Cognitive Assessment Scale Inventory, Hamilton Depression Scale, and Hamilton Anxiety Scale.Results:The mean age of subjects was 25.9 ± 8.9 years. The most prevalent neurological manifestations were (in order of frequency) anxiety in 17 cases (65.4%), depression in 15 cases (57.7%), headache in 10 cases (38.5%), peripheral neuropathy in 7 cases (26.9%), seizures in 6 cases (23.1%), psychosis in 5 cases (19.2%), dementia in 4 cases (15.4%), radiculopathy in 4 cases (15.4%), myositis in 3 cases (11.5%), and stroke in 2 cases (7.7%). There was a significant affection in amplitude of the ulnar nerve, cognitive function impairment, and electroencephalography changes. There was a significant increased mean velocity and decreased Pulsatility Index of the most studied intracranial vessels in the patients.Conclusion:The use of multimodal neurophysiological, transcranial duplex, and psychometric scales increases the sensitivity for detecting nervous system involvement.

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Elevated Cerebral Blood Flow and Volume in Systemic Lupus Measured by Dynamic Susceptibility Contrast Magnetic Resonance Imaging

Cited by 26 publications

References 39 publications

Blood Pressure and Vascular Dysfunction Underlie Elevated Cerebral Blood Flow in Systemic Lupus Erythematosus

Blood Pressure and Vascular Dysfunction Underlie Elevated Cerebral Blood Flow in Systemic Lupus Erythematosus

Libman-Sacks Endocarditis and Embolic Cerebrovascular Disease

Multimodal neurophysiological and psychometric evaluation among patients with systemic lupus erythematosus

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