Abstract P700: Stroke in Lupus Spectrum Disorder: A Single-Center Case Series in the Kentucky Appalachian Region

Abstract

Background: Lupus spectrum disorders (LSDs) encompass systemic lupus erythematosus (SLE), lupus nephritis, antiphospholipid syndrome (APS), and mixed connective tissue disease. Neuro-vascular disorders associated with LSDs include headache, transient ischemic attack, vascular cognitive impairment, immune-mediated cerebral vasculitis, thrombo-embolic stroke, cortical venous sinus thrombosis (CVST), and intracranial hemorrhage. We conducted a retrospective survey of neuro-vascular complications of LSDs in a university hospital-based stroke service within Kentucky Appalachia. Methods: Consecutive hospital admissions and consultations were retrospectively surveyed from January 2012 to January 2017. Inpatient medical records were reviewed to accumulate laboratory data and neuro-imaging studies. Diagnoses of SLE and other LSDs conformed to Systemic Lupus International Collaborating Clinics criteria. Results: During this 5-year survey, 10,953 cases of ischemic or hemorrhagic stroke were admitted or consulted and 75 patients (0.7%) met criteria for LSD. Female:male ratio favored women over men (4:1) and the median age was 48 years (range 22 - 87). The most common LSD was SLE and/or APS (n = 61; 81.3% total). The most frequent neuro-vascular complication was acute thrombo-embolic stroke (n = 30; 40%). Among 42 (56%) ischemic stroke patients, 17 had multifocal infarcts, 11 had isolated cortical strokes, and 7 had lacunes in the subcortical structures or brainstem. The majority of ischemic stroke patients (n = 48; 64%) did well and were ultimately discharged to home; 19 (25.3%) were re-admitted with recurrent stroke. Four patients had vasculitis (5.3%) and three had moyamoya syndrome (4%). Intracranial hemorrhage affected four patients (5.3%); hemorrhagic cerebral micro-angiopathy occurred in three (4%). Two patients had CVST (2.7%). Conclusion: Neuro-vascular complications of LSDs are heterogeneous and affect youthful patients with female preponderance. The large proportion of thrombo-embolic stroke in our population may be attributed to immune-mediated arterial coagulopathy or cardiac structural disease. Most patients with LSD complicated by ischemic stroke had good outcome, but there was high risk of readmission due to recurrence.