Vertebrobasilar Artery Stroke as the Heralding Sign of Systemic Lupus Erythematosus

Mohammadian, Reza; Tarighatnia, Ali; Naghibi, Mehran; Koleini, Evin; Nader, Nader D.

doi:10.1016/j.jstrokecerebrovasdis.2017.12.003

Cited by 4 publications

(5 citation statements)

References 20 publications

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“…33 A recently published study has described similar abnormalities for systemic lupus erythematodes. 34 Whether this reflects increased inflammation in the posterior circulation or a difference in vessel anatomy and hence increased susceptibility remains unclear. One hypothesis is involvement of elastic tissue in inflammation, which is thinning once the vertebral arteries reach the skull.…”

Section: Discussionmentioning

confidence: 99%

Ischemic stroke in human immunodeficiency virus-positive patients: An increasingly age-related comorbidity?

Schaefer

Stephan

Foerch

et al. 2020

European Stroke Journal

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Introduction The global incidence of ischemic stroke among patients with human immunodeficiency virus is increasing. The aim of this controlled case analysis was to study patient characteristics, stroke etiologies, and risk factors in human immunodeficiency virus-positive patients in a medical system with easy access to antiretroviral therapies. Patients and methods We conducted a retrospective, observational study of human immunodeficiency virus-positive patients treated in our stroke unit and outpatient clinic in Germany between 2012 and 2018. A control group of all patients treated for acute ischemic stroke in 2018 was used to elicit possible differences in stroke localization, etiology, and distribution of risk factors. Results Out of 3615 patients with an acute ischemic stroke, 24 (0.7%) were newly or previously diagnosed as human immunodeficiency virus-positive. Strokes in this cohort were caused by large-vessel disease (37.5%), small-vessel disease (20.8%), cryptogenic-embolism (20.8%), vasculitis (16.7%), and cardio-embolism (4.2%). Large-vessel disease-related strokes were more often located in the posterior circulation (77.8%). Compared to the control group, cardio-embolic strokes were less and vasculitis and large-vessel disease more frequent. Human immunodeficiency virus-positive patients were younger at stroke onset (53.7 ± 12.8 vs. 70.2 ± 14.6 years, p = 0.05). Discussion Although the prevalence of human immunodeficiency virus-infection among patients treated for acute ischemic strokes appears low, this collective merits special attention due to a high burden of potentially modifiable risk factors and vasculitis. Conclusion Compared to previous studies, age at stroke onset was one of the highest, supporting the hypothesis that as antiretroviral therapy increases the life expectancy of people living with HIV/AIDS, they will be increasingly affected by cardiovascular disease. Human immunodeficiency virus-related cerebral vasculitis was associated with high mortality (75%).

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Section: Discussionmentioning

confidence: 99%

Ischemic stroke in human immunodeficiency virus-positive patients: An increasingly age-related comorbidity?

Schaefer

Stephan

Foerch

et al. 2020

European Stroke Journal

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“… MRI: multiple vertebrobasilar territory infarcts Cerebral angiography: stenoses of left MCA, left vertebral, basilar and right PCA MRI scan at the age of 19 y/o: no additional lesions Leukocytosis Positive ANA Positive anti-ds-DNA Positive direct Coombs Test Positive lupus anticoagulant Oral anticoagulation IV cyclophosphamide monthly 6-months follow-up: ability to walk, ataxia, dysarthria No further events for the next 3 years 26 y/o woman [ 4 ] Acute headache, dizziness, dysarthria, quadriataxia. MRI: multiple vertebrobasilar territory infarcts Cerebral angiography: occlusion of bilateral vertebral arteries Anemia Leukocytosis Elevated ESR Weakly positive anti-ds-DNA Positive ANA Positive direct Coombs Test Lupus anticoagulant absent Antihypertensives, warfarin plus prednisolone 9-months follow-up: ability to stand and walk with assistance 24 y/o woman [ 12 ] Acute headache, right hemiparesis and gait ataxia. CT scan: normal MRI: bilateral pontine infarcts CTA: basilar artery stenosis Weakly positive ANA Positive anti-ds-DNA C3 and C4 protein depression Normal ESR Heparin IV, initially Further treatment not reported Follow-up not reported 34 y/o man [ 12 ] Acute headache, dizziness, right hemi-and gait ataxia, dysphagia and righthypesthesia MRI: right cerebellar and pontine infarcts CTA: right vertebral artery stenosis Elevated ESR Positive ANA Positive anti-ds-DNA Positive ASMA C3 and C4 protein depression …”

Section: Resultsmentioning

confidence: 99%

“… MRI: multiple vertebrobasilar territory infarcts Cerebral angiography: occlusion of bilateral vertebral arteries Anemia Leukocytosis Elevated ESR Weakly positive anti-ds-DNA Positive ANA Positive direct Coombs Test Lupus anticoagulant absent Antihypertensives, warfarin plus prednisolone 9-months follow-up: ability to stand and walk with assistance 24 y/o woman [ 12 ] Acute headache, right hemiparesis and gait ataxia. CT scan: normal MRI: bilateral pontine infarcts CTA: basilar artery stenosis Weakly positive ANA Positive anti-ds-DNA C3 and C4 protein depression Normal ESR Heparin IV, initially Further treatment not reported Follow-up not reported 34 y/o man [ 12 ] Acute headache, dizziness, right hemi-and gait ataxia, dysphagia and righthypesthesia MRI: right cerebellar and pontine infarcts CTA: right vertebral artery stenosis Elevated ESR Positive ANA Positive anti-ds-DNA Positive ASMA C3 and C4 protein depression Treatment not reported Follow-up not reported 37 y/o woman [ 12 ] Acute dizziness, right hemiparesis, horizontal nystagmus Previously misdiagnosed as Multiple Sclerosis MRI: multiple cerebellar and pontine ischemic lesions CTA: left vertebral artery stenosis, hypoplastic right vertebral artery LE cells absent Normal ESR Positive anti-ds-DNA C3 and C4 protein depression Treatment not reported Follow-up not reported 27 y/o woman, 5th month of pregnancy [ …”

Section: Resultsmentioning

confidence: 99%

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

2018

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Stroke is a frequent occurrence among patients suffering from systemic lupus erythematosus (SLE), but it rarely occurs as the initial manifestation of the disease. We here present the case of a 37 year-old patient who developed an acute cerebellar ischemic stroke as initial event of SLE: elevated partial thromboplastin time and ESR, thrombocytopenia, anti-ds-DNA, anti-SSA, anti-JO-1, and the lupus anticoagulant were detected, and the diagnosis of SLE was established. In addition, we reviewed the literature in order to clarify the demographic, clinical, imaging and outcome characteristics of such a presentation, and found 10 similar cases. Most patients were young (age 31.7 ± 8.5 years) and women (8/11, 72.7%). Stroke most often affected the vertebrobasilar territory (7/11, 63.6%). The stroke mechanism was not clearly defined in these cases. Treatment with immunosuppression and anticoagulation was considered to be a reasonable choice for early secondary stroke prevention. The occurrence of ischemic stroke, primarily in the vertebrobasilar system among young patients, especially women, should always raise suspicion for underlying SLE, and prompt diagnostic investigations to confirm or exclude its presence.

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“…Consequently, 10 articles were finalized that reported on cases of SLE with ischemic stroke as the initial presentation, documenting a total of 17 cases. [3][4][5][6][7][8][9][10][11][12] Adding the three cases presented in this study, a total of 20 cases with ischemic stroke as the initial manifestation of SLE were included. Among these cases, there were 6 males and 14 females, with ages ranging from 16 to 55 years.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…Among them, 9 studies were excluded as they focused on stroke occurrence post‐SLE diagnosis. Consequently, 10 articles were finalized that reported on cases of SLE with ischemic stroke as the initial presentation, documenting a total of 17 cases 3–12 . Adding the three cases presented in this study, a total of 20 cases with ischemic stroke as the initial manifestation of SLE were included.…”

Section: Review Of the Literaturementioning

confidence: 99%

Three cases of systemic lupus erythematosus presenting with ischemic stroke as the initial symptom: Case reports and literature review

Li,

Liu,

et al. 2024

Immunity Inflam & Disease

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BackgroundIschemic stroke constitutes a grave complication within the context of systemic lupus erythematosus (SLE), typically manifesting several years postdiagnosis of SLE. Incidents where ischemic stroke precedes and acts as an initial symptom of SLE are comparatively rare in its early stages, and such presentations are frequently misdiagnosed as ischemic cerebrovascular diseases, posing significant diagnostic challenges.Case ReportsThis article presents three cases of young females in whom ischemic stroke emerged as the initial manifestation of SLE. It incorporates a review of 17 case reports published over the past two decades, focusing on patients with SLE where ischemic stroke was a primary symptom. This discussion encompasses the clinical presentation, outcomes, and therapeutic approaches for these patients.ConclusionIn young patients, particularly females presenting with ischemic stroke and especially in cases accompanied by hematologic or multisystemic involvement, there should be heightened vigilance for SLE‐induced ischemic stroke. Early diagnosis and treatment significantly enhance patients' quality of life and survival rates.

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Vertebrobasilar Artery Stroke as the Heralding Sign of Systemic Lupus Erythematosus

Cited by 4 publications

References 20 publications

Ischemic stroke in human immunodeficiency virus-positive patients: An increasingly age-related comorbidity?

Ischemic stroke in human immunodeficiency virus-positive patients: An increasingly age-related comorbidity?

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

Three cases of systemic lupus erythematosus presenting with ischemic stroke as the initial symptom: Case reports and literature review

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