Abstract
Objectives: The objectives of this article are twofold: To review the value and the variability of MR imaging (MRI) findings in patients with systemic lupus erythematosus (SLE) and to reveal the frequency of central nervous system (CNS) involvement. SLE is a complex multisystem autoimmune connective tissue disorder with a broad spectrum of clinical presentations. Materials and methods: We present three cases, two with neurological symptoms and one case with musculoskeletal symptoms. Patients were imaged in the MRI department of the University Hospital of Patras. All patients had a previous history of antiphospholipid syndrome and known SLE. Results: None of the pts had a normal brain MRI. Abnormal lesions were typically high on FLAIR and T2-weighted images. One patient showed myositis of the tibial muscles bilateral and although she did not reveal any neurological symptoms, because of the presence of APS, she underwent brain MRI to detect any cerebrovascular involvement. The brain MRI was abnormal and showed extensive lesions and porencephalia. In all cases the differential diagnosis of the brain MRI included vasculitis, focal ischemia, multiple sclerosis or other entities. Parenchymal volume loss-cerebral atrophy, incompatible with their age, was obvious in all patients. Conclusion: Magnetic resonance imaging is the gold standard for the investigation of central nervous system in patients suffering from lupus. Lupus patients who also develop antiphospholipid syndrome must be submitted to brain MRI because central nervous involvement is very common and serious, although symptoms may be silent as in our case.
Highlights
systemic lupus erythematosus (SLE) is a complex multisystem autoimmune connective tissue disorder with a broad spectrum of clinical presentations
Abnormal lesions were typically high on Fluid-attenuated inversion-recovery (FLAIR) and T2-weighted images, most frequently in the subcortical and deep white matter in the frontal and parietal lobes
The brain MR imaging (MRI) was abnormal with subcortical lesions extended to the cortex in the left parietal lobe, focal lesions in the deep white matter bilateral, as well as porencephalic lesions with peripheral gliosis on the left parietal lobe, compatible with old infarct
Summary
SLE is a complex multisystem autoimmune connective tissue disorder with a broad spectrum of clinical presentations. It affects almost all organ systems and tissues [1]. Neurologic and musculoskeletal manifestations are among its features. Central nervous system (CNS) lupus is a serious illness, which should be in the differential diagnosis for many neurologic conditions. Patients who have antiphospholipid antibodies (APL-Ab) are at additional risk for central nervous involvement and neuropsychiatric event [2] [3]. Musculoskeletal involvement in lupus patients is common with characteristic manifestations, especially symmetric polyarthritis, deforming non-erosive arthropathy, myositis, osteomyelitis, osteonecrosis and septic arthritis [4]
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