Abstract
The objective of the present study was to identify the single photon emission computed tomography (SPECT) and magnetic resonance (MR) findings in juvenile systemic lupus erythematosus (JSLE) patients with CNS involvement and to try to correlate them with neurological clinical history data and neurological clinical examination. Nineteen patients with JSLE (16 girls and 3 boys, mean age at onset 9.2 years) were submitted to neurological examination, electroencephalography, cerebrospinal fluid analysis, SPECT and MR. All the evaluations were made separately within a period of 15 days. SPECT and MR findings were analyzed independently by two radiologists. Electroencephalography and cerebrospinal fluid analysis revealed no relevant alterations. Ten of 19 patients (53%) presented neurological abnormalities including present or past neurological clinical history (8/19, 42%), abnormal neurological clinical examination (5/19, 26%), and abnormal SPECT or MR (8/19, 42% and 3/19, 16%, respectively). The most common changes in SPECT were cerebral hypoperfusion and heterogeneous distribution of blood flow. The most common abnormalities in MR were leukomalacia and diffuse alterations of white matter. There was a correlation between SPECT and MR (P<0.05). We conclude that SPECT and MR are complementary and useful exams in the evaluation of neurological involvement of lupus.
Highlights
In 16 to 52% of the patients with juvenile systemic lupus erythematosus (JSLE), a wide spectrum of neuropsychiatric manifestations may occur at any time during the course of the disease [1,2,3,4,5,6,7]
The neurological clinical history was positive in 8/19 patients; in two patients who presented abnormalities in both single photon emission computed tomography (SPECT) and magnetic resonance (MR), no neurological sign or symptom was observed
Our findings are in agreement with those reported by Russo et al [13]
Summary
In 16 to 52% of the patients with juvenile systemic lupus erythematosus (JSLE), a wide spectrum of neuropsychiatric manifestations may occur at any time during the course of the disease [1,2,3,4,5,6,7]. Single photon emission computed tomography (SPECT) has been used to evaluate cerebral perfusion in children with lupus [8,9]. Szer et al [8], studying five JSLE patients with severe clinical signs of neurological involvement, observed SPECT abnormalities in all of them, but MR alterations in only three. Reiff et al [9] studied the SPECT and MR of ten JSLE patients with CNS involvement and found abnormal SPECT changes in all patients and MR alterations in six of ten patients
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