Unusual neurologic manifestations (I): Parkinsonism in juvenile SLE

Khubchandani, Raju; Venkataraman, Viswanathan; Desai, Joy

doi:10.1177/0961203307081421

Cited by 33 publications

(34 citation statements)

References 18 publications

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“…Cerebral hyperperfusion in SLE has been reported previously, but only in the basal ganglia of SLE patients with Parkinsonian syndrome using relative measures of perfusion with SPECT (35, 36). However, in a study that included at least one patient with SLE, quantitative PET was used to observe higher CBF throughout the brain of patients with renal disease relative to healthy control subjects (24).…”

Section: Discussionmentioning

confidence: 82%

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

Gasparovic¹,

Roldan²,

Sibbitt³

et al. 2010

J Rheumatol

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Objective Several studies have examined abnormalities in cerebral blood flow (CBF) in patients with systemic lupus erythematosus (SLE). However, the majority of these studies have reported CBF relative to a region assumed to be normal in the brain. The purpose of the present study was to examine absolute differences in both regional CBF and cerebral blood volume (CBV) between SLE patients and healthy control subjects. Methods CBF and CBV were measured with dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI), a technique that provides an alternative to radionuclide perfusion studies and permits quantitative anatomic, CBF, and CBV imaging in a single scanning session. CBF and CBV were measured in both lesions and normal appearing tissue in the major cerebral and subcortical brain regions. Unlike most past perfusion studies on SLE, CBF and CBV values were not normalized to a region of brain assumed to be healthy. Results As expected, CBF and CBV within MRI-visible lesions were markedly reduced relative to surrounding normal appearing white matter. However, both CBF and CBV in normal appearing tissue were higher in SLE patient groups, with or without lesions, relative to the control group. Conclusion DSC MRI, without normalization to a region presumed to be healthy, revealed that CBF and CBV in normal appearing tissue in SLE patients is higher than CBF and CBV in control subjects. Since this finding was made in subgroups of patients with and with out lesions, the higher CBF and CBV appears to precede lesion pathology.

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Section: Discussionmentioning

confidence: 82%

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

Gasparovic¹,

Roldan²,

Sibbitt³

et al. 2010

J Rheumatol

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“…Nevertheless, the unique observational data of the present study obtained by noninvasive transcranial Doppler support our recent report of increased cerebral blood flow in SLE using other methodologies (30). Despite the widespread reports of heterogeneous hypoperfusion in NPSLE, cerebral hyperperfusion in SLE has been noted in a number of prior reports using single photon emission tomography (SPECT), positron emission tomography (PET), or magnetic resonance perfusion-weighted imaging (MRPWI) (30–32). Hyperperfusion and altered vascular tone also have been reported in other neurological disorders, including stroke (33), occlusive sickle cell disease (34), transient ischemic attack (35) seizures and epilepsy (36), traumatic brain injury (37), metabolic brain disease (38), and migraine (39).…”

Section: Discussionmentioning

confidence: 99%

Middle cerebral artery resistivity and pulsatility indices in systemic lupus erythematosus: evidence for hyperperfusion

Greene

Yonan

Sharrar

et al. 2011

Lupus

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Background and purpose Systemic lupus erythematosus (SLE) is associated with significant cerebrovascular and neuropsychiatric disease for which multiple pathogeneses have been proposed. Although global cerebral hypoperfusion has been proposed, there are limited data about intracerebral arterial hemodynamics. Transcranial Doppler (TCD) allows portable, high temporal and spatial resolution, noninvasive blood velocity measurements in the middle cerebral arteries, and calculations of standard resistivity (RI) and pulsatility (PI) indices. RI and PI correlate with cerebral hemispheric arteriolar tone, blood flow resistances, and impedances. Accordingly, we hypothesized that there would be significant differences (p<0.05) in RI and PI between SLE patients and healthy, age and gender matched controls. Methods TCD was used to measure RI and PI bilaterally on 34 stable SLE patients (35±11 years) and 15 control subjects (34±10 years). Patients and controls had similar, normal blood pressures and were examined in the supine position during normal, resting respiration. RI and PI were determined by a blinded, experienced observer. Results There were no significant differences in RI and PI bilaterally within each cohort. However, SLE patients had significantly lower average RI and PI values compared with controls: 0.45±0.10 versus 0.52±0.05 (p<0.05); and 0.65±0.19 versus 0.77±0.12, (p<0.05); respectively. Conclusions These preliminary data suggest that RI and PI values in the human middle cerebral artery are significantly lower in SLE compared with controls. These indices indicate that middle cerebral arterial resistances and impedances are decreased in SLE. Under normotensive conditions, the results are consistent with hyperperfusion in SLE with increased arteriolar dilation and increased cerebral blood flow.

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“…Improvements have been reported in those patients treated with combination of steroids and cyclophosphamide, with or without antiparkinsonian drugs. 10 In two cases, intravenous injection of immunoglobulins appeared to be effective after methylprednisolone and cyclophosphamide failed. 11 Intrathecal injection of MTX plus DXM, which was assumed to enhance 21 To our knowledge, our patient was the first NPSLE patient with parkinsonism reported to accept intrathecal injection of MTX plus DXM and obtain a satisfactory outcome.…”

Section: Discussionmentioning

confidence: 95%

“…3 Since then, only about 30 NPSLE cases with parkinsonism have been reported to date (Table 1). [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Autoantibodies and immune-mediated vasculopathy was suggested in the pathogenesis of parkinsonism in NPSLE. 20 Kunas et al 4 found antibodies to dopaminergic cells in serum from the NPSLE patients manifested with parkinsonism.…”

Section: Discussionmentioning

confidence: 99%

Parkinsonism as a Manifestation of Neuropsychiatric Systemic Lupus Erythematosus: A Case Report and Literature Review

et al. 2015

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Unusual neurologic manifestations (I): Parkinsonism in juvenile SLE

Cited by 33 publications

References 18 publications

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

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

Middle cerebral artery resistivity and pulsatility indices in systemic lupus erythematosus: evidence for hyperperfusion

Parkinsonism as a Manifestation of Neuropsychiatric Systemic Lupus Erythematosus: A Case Report and Literature Review

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