Stroke as an early manifestation of systemic lupus erythematosus.

Abstract

Coagulation studies were normal. Anti-nuclear factor was positive to 1:80. The ESR was 27 mm/h, normal for the stage of pregnancy. Bone marrow examination showed increased numbers of megakaryocytes. Within 2 months platelets returned to normal without treatment. Three months after the completion of the pregnancy, and the episode of transient cerebral ischaemia, spontaneous leg bruising occurred. There was now severe thrombocytopenia (platelets 10 x 109/l). DNA binding was 45 units per ml, Sm antibody positive and C3 and C4 fractions of the complement depressed. Prednisone 60 mg daily reducing to 10 mg daily was started. In the 12 months that followed there were five or six further transient left hemipareses. Platelet numbers were now normal. Platelet aggregation studies showed reduced aggregation with ADP, adrenalin, collagen and ristocetin but the bleeding time was prolonged (15 minutes). Dipyridamole (400 mg daily) was added to the prednisone (10 mg daily). In the subsequent 8 months there were no further hemiparetic attacks but frequent skin urticarial lesions occurred. CT scan was normal.Case 3 A 41-year-old woman suffered hepatitis and the following year seronegative polyarthritis associated with an

Inflammation and Infection in Clinical Stroke

“…Systemic lupus erythematosus (SLE), a chronic autoimmune multisystem connective tissue disease, may be complicated by stroke, or occasionally present with stroke as an early manifestation (Haas, 1982). Both cerebral infarcts and hemorrhages may occur.…”

Ischemic stroke as initial manifestation of systemic lupus erythematosus: A case report and review of the literature

“… Five or six TIAs within the next 12 months Dipyridamole 400 mg per day was added. No further events for the next 8 months 41 y/o woman, history of hepatitis and seronegative polyarhtritis [ 5 ] Recurrent episodes of right hemiparesis [ 3 ] during 3 years CT scan: cerebral atrophy, right temporo-parietal infarct Normal ESR Anti-Sm antibody absent IgG elevation Findings in renal biopsy DNA binding elevation Positive anti-ds-DNA Positive LE cells Treatment not reported Persistent right facial weakness Progressive dementia followed 46 y/o woman, history of paranoid psychosis [ 5 ] Bilateral retinal artery occlusion Epileptic seizures occurred 15 days after Transient right hemiparesis 1 day later Serial isotope scans: right frontal lobe infarct CT scan at the age of 52 y/o: severe cerebral atrophy, infarcts in both temporal, left frontal and left parietal lobes. Elevated ESR Three months later: positive antinuclear factor, elevated DNA binding, positive WR, C3 and C4 protein depression, renal function impairment Findings in renal biopsy Treatment not reported Focal and generalized seizures after 3 years, associated with prednisone-induced hyperglycemia and severe hypertension.…”

“…It is not unusual to encounter ischemic stroke in the course of SLE [ 3 , 5 , 7 ]. This may be in part related to SLE disease activity and in part to the operation of classic stroke risk factors, such as hypertension, dyslipidemia and others, which often accompany SLE and its treatment [ 8 , 9 ].…”

“…Stroke events are frequent among patients suffering from SLE, affecting 3–20% of them, mainly in a young for stroke population, and usually within the first 5 years from diagnosis [ [1] , [2] , [3] , [4] ]. The diagnosis of SLE is usually established before any stroke occurrence [ 5 ]. The risk of stroke is 8 times higher in SLE patients compared to the general population [ 3 ], and the risk for cardiovascular events is increased by 3% every year after diagnosis [ 1 ].…”

Non-atheromatous causes of cerebral infarction

“…The high incidence of cerebral infarction with systemic lupus erythrematosus (S.L.E.) is related not only to direct involvement of cerebral arteries, occasionally presenting with hemiplegia in an otherwise asymptomatic person (Haas, 1982), but also to the presence of an antilipid antibody-the so-called lupus anticoagulant (Hughes, 1983), often associated with a false positive luetic reaction,-and to microemboli arising from verrucous endocarditis. S.L.E.…”