Systemic lupus erythematosus: imaging of central nervous system involvement by magnetic resonance

Abstract

Patients with systemic lupus erythematosus (SLE) can develop dysfunction of the central nervous system (CNS) and have several neurologic syndromes with heterogeneous pathogenic mechanisms. The most common neurologic manifestations of SLE are organic mental syndromes, functional psychoses and seizures. We retrospectively reviewed the magnetic resonance imaging (MRI) of SLE patients with CNS involvement followed in S. João Hospital Rheumatology clinic. Only patients with abnormal MRI were selected. In 42 patients studied there were 22 (52,4%) cases with abnormal MRI. Patient's age ranged between 20 and 63 years (mean 35,6). All were females. MRI showed multiple periventricular white matter lesions in 16 cases (68,2%) and cerebral infarctions in 3 cases (13,6%). There were atrophic changes in 4 cases (18,2%) and cerebral hemorrhage in 2 cases (9,1%). There was a case (4,5%) of transverse myelitis associated with acute optic neuritis (Devic's syndrome) and 1 case (4,5%) of predominantly posterior white matter signal abnormalities (reversible posterior leukoencephalopathy syndrome). This study confirms MRI importance on in identifying and characterizing CNS abnormalities, which contributes to better investigation and management of these patients. The authors discuss etiological possibilities of the different imagiological findings.