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CENTRAL NERVOUS SYSTEM INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS: MAGNETIC RESONANCE IMAGING AND CEREBROSPINAL FLUID ANALYSIS
Introduction
Slide 3
Slide 4
Slide 5
Objective
Inclusion criteria
Exclusion criteria
CSF
Slide 10
MRI
White matter lesions
Slide 13
Atrophy
Slide 15
Statistics
Demographic data
Results
Slide 19
MRI findings
Slide 21
Cerebral Volume
Slide 23
Serum findings
Associations
CSF findings in SLE
CSF findings
Slide 28
Slide 29
Discussion
Slide 31
Slide 32
Conclusions
Acknowledgments
Nội dung
CENTRAL NERVOUS SYSTEM INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS: MAGNETIC RESONANCE IMAGING AND Simone Appenzeller CEREBROSPINAL FLUID ANALYSIS State University of CampinasUNICAMP, Campinas, Brazil Introduction Central nervous system (CNS) manifestations occur in up to 70% of SLE patients, depending on criteria applied for diagnosis Symptoms are diverse Secondary causes must be excluded – – – – Hypertension Infections Metabolic abnormalities Drug toxicity Introduction Pathogenesis: – Autoantibodies and cytokine mediated neuronal dysfunction – Intracranial angiopathy – Coagulopathy Introduction Magnetic resonance imaging is considered gold standard for diagnosis of anatomic brain abnormalities Findings are diverse – – Cerebral atrophy White matter lesions Poor clinical correlations Introduction Neuroimage 2007;34(2):694-701 Objective To evaluate cerebrospinal fluid (CSF) and MRI findings in SLE with active and inactive CNS involvement Inclusion criteria 30 SLE with CNS manifestations (ACR, 1999) – Active – Inactive Drug free state or stable low doses of immunosuppressive therapy for at least months (10 mg of prednisone or equivalent, 100 mg/day azathioprine) Controls with similar age and gender distribution – – No chronic disease CSF: mielography CT Exclusion criteria Not able to undergo MRI exams – Claustrophobia, pacemaker and prosthetic valves Previous clinical conditions that could influence cerebral atrophy – – – – – – – history of stroke epilepsy arterial hypertension diabetes mellitus alcohol and drug abuse renal insufficiency and malignancy Patients who fulfilled the ACR criteria for Sjogren syndrome 10 patients excluded CSF CSF (10 mL) samples: – CSF leukocyte count – IgG synthesis and – oligoclonal IgG bands Paired samples of serum and CSF were stored at 80º C All measures were made at a single occasion in order to minimize the intra assay variability IgG and albumin: – measured by nephelometry (BNII; Dade Behring, Marburg, Germany), and – Blood-brain barrier function: CSF albumin/serum albumin – Intrathecal synthesis: Link Indexes (LI): CSF IgG/CSF albumin/serum albumin Oligoclonal IgG bands: – identified by isoelectrofocusing CSF The IL12, IFNg, TNFa, and IL10: – quantified using commercial kits from Biosource International, Nivelles, Belgium – Intratecal synthesis: serum albumin/CSF albumin*CSF Il12/serum Il12 MRI findings SLE patients: – Atrophy: (25%) – Hyperintense white matter lesions: 12 (60%) – Demyelinating lesions: (15%) No correlation to clinical findings Controls: all normal MRIs MRI findings Localization Number of lesions Periventricular 12 Basal ganglia/ internal capsule Callosal/ subcallosal Juxta cortical 22 Brain stem 15 Cerebral cortex 19 578 Cerebral Volume P=0,002 SLE Controls Cerebral Volume 20000 P0,05 15000 10000 5000 0.5 SLE 1.0 w/inactive CNS 1.5SLE w/ 2.0 active CNS CNS 2.5 3.0 Controls 3.5 Serum findings 1500 1500 P