Middle cerebral artery involvement in systemic lupus erythematosus presenting as a stroke – an unusual initial presentation of the disease

Sideras, Panagiotis; Jacob, Joël; Mann, Amitasha; Singh, Jaswinder; Buzzola, Rino; Abrudescu, Adriana

doi:10.1016/j.jocn.2012.03.003

Cited by 2 publications

(2 citation statements)

References 17 publications

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“…First, the treatment for the inflammatory process of NPSLE with the use of steroid pulse therapy 13,14 and plasmapheresis 12,15 have been reported successful in ischemic stroke patients. Despite the rapid treatment with anticoagulation, steroid pulse therapy, and plasmapheresis, our patient developed yet another ischemic stroke involving the ACA and MCA with subsequent hemorrhagic transformation and brain edema.…”

Section: Discussionmentioning

confidence: 99%

A challenging case of neuropsychiatric systematic lupus erythematosus with recurrent antiphospholipid- related stroke: A case report and literature review

Shih

Chang

et al. 2019

Neurol Int

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Neuropsychiatic systematic lupus erythematosus (NPSLE) is a form of SLE involves the inflammation and/or thrombotic event in the nervous system. Patients with NPSLE are likely to have a positive antiphospholipid antibody (aPL), therefore are at higher risk of recurrent ischemic stroke. The management of NPSLE with aPLrelated stroke is rather different from the traditional ischemic stroke. One must treat it with anticoagulation and immunosuppressive therapy. The present case is a 47-yearold Taiwanese female with NPSLE and positive aPL, presented with a recurrent MCA ischemic stroke. Initial laboratory results showed significantly elevated levels of anti-ANA, anti-dsDNA, anti-cardiolipin, and decreased complement levels. Due to multiple contraindications for tPA, she was treated with antiplatelet, anticoagulation, steroid pulse therapy, and plasmapheresis during the hospitalization. Despite treatments, her stroke progressed to multi-focal lesions, involving the ACA, MCA, and basal ganglion. On follow up of her brain CT scan showed tissue edema and suspicious for subfalcine herniation. Responding to this clinical deterioration, we stopped warfarin and started mannitol. Eventually, her condition improved and was transferred to the rehabilitation program. Currently, there is no unified guideline regarding the secondary prevention of ischemic stroke in NPSLE with aPL patients. Additionally, previously reported use of steroid pulse therapy and plasmapheresis can potentially harm the patient. Clinicians must be cautious when treating such patient.

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Section: Discussionmentioning

confidence: 99%

A challenging case of neuropsychiatric systematic lupus erythematosus with recurrent antiphospholipid- related stroke: A case report and literature review

Shih

Chang

et al. 2019

Neurol Int

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“…1,2 Patients with SLE with accompanying central nervous system (CNS) abnormalities are categorized as having neuropsychiatric SLE (NPSLE) and may present with a variety of neurological, psychological, and psychiatric complications such as headache, seizure, anxious mood, cognitive impairment, psychosis, infarction, stroke, hemorrhage, and brain atrophy. 3 The corpus callosum is an important brain region that contains many white matter fibers that connect both hemispheres of the brain and plays an important role in neuropsychological disorders. [4][5][6][7] Previous volumetric studies have shown that the whole brain, gray matter, cortical, 8 and corpus callosal volumes 9 were significantly smaller in patients with NPSLE than in control subjects.…”

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confidence: 99%

Automatic Segmentation of the Corpus Callosum Using a Cell-Competition Algorithm

Lee

Cheng

et al. 2015

Journal of Computer Assisted Tomography

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Middle cerebral artery involvement in systemic lupus erythematosus presenting as a stroke – an unusual initial presentation of the disease

Cited by 2 publications

References 17 publications

A challenging case of neuropsychiatric systematic lupus erythematosus with recurrent antiphospholipid- related stroke: A case report and literature review

A challenging case of neuropsychiatric systematic lupus erythematosus with recurrent antiphospholipid- related stroke: A case report and literature review

Automatic Segmentation of the Corpus Callosum Using a Cell-Competition Algorithm

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