[Diagnosis of lesions of the central nervous system in patients with systemic lupus erythematosus]

A total of 60 patients with systemic lupus erythematosus (SLE) were under observation; 36 of them had clinical symptoms of the CNS affection and 25 persons included into the control group exhibited no psychic disorders during the clinical examination. Besides, routine clinico-laboratory examinations accepted in rheumatology, the patients were subjected to cranial computer tomography (CT), electroencephalography, examination of cerebral hemodynamics with a radionuclide partechnetate 99mC as well as to psychological testing. Neuropsychic disorders developed during the first four years after the onset of the disease and are grouped in the following way: neurological, border-line, neuropsychic, affective, psychotic, intellectual-mnestic. Moderate affection of the CNS in SLE is characterized by a complex of subjective and objective symptoms: headache, deterioration of memory, insomnia, vertigo, irritability, depressed mood, assymetry of the face innervation, coordinatory disorders. Diffuse widening of the subarchnoidal space, diffuse cerebral changes, interhemispheric assymetry of the venous and arterial phases of cerebral circulation: the most peculiar symptoms of the CNS affection in SLE according to CT and EEG and radionuclide studies of cerebral hemodynamics. Focal changes in the CNS were observed in 50% of the patients with neuropsychic disorders.

[Quantitative characteristic of circulating immune complexes in patients with lupus erythematosus and central nervous system disorders]

Molecular weight and concentration characteristics of immune complexes (IC) from 19 sera of patients with systemic lupus erythematosus (SLE) and CNS impairment have been obtained by the rapid nephelometry assay. Basing on cranial CT findings, the examinees were divided into 2 groups. Group I included patients with cerebral cysts and local dilation of subarachonid spaces, group II those with the above dilatation or that of ventricles of the brain. Small-size IC were registered in 14 sera, their relative molecular mass being under the values derived for donors and SLE patients without CNS affections whereas their level exceeded such in donor sera. Larger IC relative concentrations were seen in group I patients than in group II ones (34 +/- 13 and 18.7 +/- 12, respectively). Five patients failed to demonstrate IC. The presence of small-size IC in high concentrations may be considered a marker of CNS involvement in SLE, the highest concentrations suggesting local impairment of the brain.

[Lesions of the central nervous system in systemic lupus erythematosus in the computerized-tomographic image]

Computed tomography (CT) of the brain was employed in 40 patients with systemic lupus erythematosus (SLE). Clinical cerebral pathology was obvious in 30 and absent in 10 patients. By CT cerebral symptoms were divided of 4 groups. Clinical symptom complexes of CNS defects and SLE were reflected on definite CT images, e. g. digital capillaritis, marked livedo. Raynaud's syndrome, disseminated erythematous skin lesions correlated with CT-shown focal damage to the brain. CT picture of enlarged subarachnoid space, ventricles and basal cisterns can be observed in SLE patients without neurological symptoms. This indicated likely subclinical cerebral affection.

Eosinophilic fasciitis. Review and report of six cases

Six patients with eosinophilic fasciitis are presented. This syndrome is characterized by indurative swellings of arms and legs, with rapidly progressing difficulties in extending elbows, wrists, and fingers, and often limited motion of shoulders and ankle joints. Pain when contracting muscles, and weakness of proximal muscles and hand grip are common features. The frequent occurrence of localized skin lesions has presented differential diagnostic difficulties to systemic sclerosis and to polymyositis. Visceral involvement and Raynaud's phenomena, however, are absent or mild. Blood eosinophilia, hypergammaglobulinemia, and unspecific signs of inflammation are found. Biopsy of muscle fascia gives characteristic histopathological findings of cell infiltrations (mostly mononuclear cells, frequently eosinophils) and vascular proliferation, in the middle layer of a thickened fascia. Skin changes are prevalent, but not conclusive for the diagnosis, and myositis in some patients might be difficult to distinguish from polymyositis. The importance of the clinical recognition of eosinophilic fasciitis and the inclusion of fascia in diagnostic muscle biopsies, is underlined.