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Lee JJ, Park SM, Park KI, Kang K, Lee WW, Kim BK, Kim YS, Yoo I. Clinical and diagnostic characteristics of Hashimoto's encephalopathy: a single-center, retrospective study. Acta Neurol Belg 2024:10.1007/s13760-024-02520-1. [PMID: 38861245 DOI: 10.1007/s13760-024-02520-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/24/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND AND PURPOSE Diagnosing Hashimoto's encephalopathy (HE) is challenging. In contrast to other types of autoimmune encephalitis, HE shows an excellent response to steroid treatment. We aimed to investigate the rates of antithyroid antibodies (ATAs) and probable HE in patients with unexplained mental dysfunction and compare the clinical characteristics between the good- and poor-outcome groups. METHODS We retrospectively reviewed the medical records and electroencephalography (EEG) and neuroimaging findings of patients admitted to the Department of Neurology of our hospital from March 1, 2006, to February 28, 2023. Using our proposed diagnostic criteria for probable HE, we compared the clinical characteristics between the good- and poor-outcome groups. We also investigated the rates of ATA positivity and probable HE. RESULTS In total, 198 patients exhibited altered mentation, rapidly progressive cognitive decline, or myoclonus. ATA tests were performed on 86 patients, and the detection rates of ATAs and probable HE were 29.1% and 25.6%, respectively. Of the 22 patients enrolled, the good- and poor-outcome groups comprised 19 and 3 patients, respectively. Clinical seizures occurred in seven patients. Nonconvulsive status epilepticus on EEG was observed in six patients, all of whom were intractable to antiepileptic drugs. Nineteen of 21 patients (90.5%) treated with immunosuppressants showed good outcomes. CONCLUSIONS HE is a rare clinical disorder, but not as rare as previously thought. When HE is suspected, steroids should be considered the first-line treatment. Early diagnosis and adequate treatment are critical to achieve good outcomes in HE.
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Affiliation(s)
- Jung-Ju Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbisekro, Noweongu, Seoul, 01830, Korea
| | - Soo-Min Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbisekro, Noweongu, Seoul, 01830, Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, 152 Teheran-Ro, Gangnam-Gu, Seoul, 06236, Korea.
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbisekro, Noweongu, Seoul, 01830, Korea
| | - Woong Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbisekro, Noweongu, Seoul, 01830, Korea
| | - Byung Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbisekro, Noweongu, Seoul, 01830, Korea
| | - Yong Soo Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbisekro, Noweongu, Seoul, 01830, Korea
| | - Ilhan Yoo
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbisekro, Noweongu, Seoul, 01830, Korea
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Lin YR, Chou LC, Chen HC, Liou TH, Huang SW, Lin HW. Increased Risk of Dementia in Patients With Systemic Lupus Erythematosus: A Nationwide Population-Based Cohort Study. Arthritis Care Res (Hoboken) 2017; 68:1774-1779. [PMID: 27111329 DOI: 10.1002/acr.22914] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/25/2016] [Accepted: 04/05/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder characterized by varied clinical symptoms and can be comorbid with neuropsychiatric disorders. However, the association between SLE and dementia risk in patients with SLE remains unclear. In this study, we evaluated the incidence of dementia in patients with SLE. METHODS Patients were recruited from a nationwide cohort in 2004-2008 and categorized as SLE (n = 1,074; patients diagnosed with SLE) or non-SLE (n = 5,370; age- and sex-matched controls). Each patient was followed for up to 7 years, until either receiving a diagnosis of dementia or until December 31, 2010. Data were analyzed using the Kaplan-Meier method and Cox regression analysis. RESULTS The incidence rate of dementia was higher in the SLE cohort (357 per 100,000 person-years) than in the non-SLE cohort (180 per 100,000 person-years). Patients with SLE had a higher risk of dementia than did those without SLE (crude hazard ratio [HR] 1.92; P < 0.05). Cox regression analysis revealed an adjusted HR for dementia in the SLE cohort of 2.14 (P < 0.001), after adjustment for other comorbid diseases and variables. CONCLUSION Patients with SLE have a higher risk of dementia.
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Affiliation(s)
- Yu-Ru Lin
- Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Lin-Chuan Chou
- Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hung-Chou Chen
- Shuang Ho Hospital and College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Shuang Ho Hospital, College of Medicine, and Graduate Institute of Injury Prevention, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Shuang Ho Hospital and College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Soochow University and Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Hajighaemi F, Etemadifar M, Bonakdar ZS. Neuropsychiatric manifestations in patients with systemic lupus erythematosus: A study from Iran. Adv Biomed Res 2016; 5:43. [PMID: 27099856 PMCID: PMC4815521 DOI: 10.4103/2277-9175.178795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 05/12/2015] [Indexed: 12/31/2022] Open
Abstract
Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious and well-known complication of systemic lupus erythematosus (SLE). There is limited evidence about the prevalence of NPSLE and its manifestations in Iran. The aim of this study was to study clinical and demographic characteristics of patients with NPSLE in an Iranian population. Materials and Methods: This was a cross-sectional study that was undertaken in two referral Clinics of Neurological and Rheumatological Disorders in Alzahra Hospital, Isfahan, Iran. Between March 2004 and June 2010, medical records of registered patients with SLE were examined. NPSLE was characterized using the American College of Rheumatology case definitions. Descriptive statistics and logistic regression were performed for statistical assessment. Results: Among 556 patients with SLE, 121 (21.7%) patients were diagnosed as NPSLE and enrolled in the study. Of whom, 94 patients were female (77.7%) and 27 patients were male (22.3%) with a female to male ratio of 3.48:1. The most common NPSLE manifestations were headache (38.8%), cerebrovascular disease (CVD) (38.8%) and seizure (26.4%). Thirty-nine patients have psychiatric disorders. Among them, 32 patients (26.4%) have periods of psychosis and mood disorder was found in 6 patients (5%). Conclusions: We identified NPSLE manifestations in 21.7% of patients; headache and CVD were the most frequent neurological manifestations. Continued studies into the pathogenesis of neurological involvement in patients with SLE are warranted.
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Affiliation(s)
| | - Masoud Etemadifar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Sayed Bonakdar
- Department of Rheumatology and Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Zimmermann N, Corrêa DG, Kubo TA, Netto TM, Pereira DB, Fonseca RP, Gasparetto EL. Global Cognitive Impairment in Systemic Lupus Erythematosus Patients: A Structural MRI Study. Clin Neuroradiol 2015; 27:23-29. [PMID: 25967601 DOI: 10.1007/s00062-015-0397-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/11/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study investigated differences in subcortical brain volumes of SLE patients with cognitive deficits (SLE-CD) and SLE patients with normal cognitive performance (SLE-CN), regardless of the presence of other neuropsychiatric symptoms. METHOD We studied 40 patients divided into two-matched groups (SLE-CD n = 20; SLE-CN n = 20), with age ranging from 21 to 63 years old (100 % female) and 14.73 ± 10.18 years of diagnosis. Magnetic resonance imaging exams were performed on a 1.5 T scanner. A neuropsychological flexible battery was applied individually, including reasoning/problem-solving, praxis, episodic and working memory, processing speed, language/fluency, executive functions (inhibition and flexibility), and sustained attention. Z score ≤ - 2.0 in any dimension was considered as a cut-off for being considered to possess cognitive deficits. One-way analyses of covariance (ANCOVA) were performed to compare the brain structure volumes between groups. The analyses were controlled for the effects of lupus-related neuropsychiatric disorders. RESULTS SLE patients with cognitive deficits had significantly smaller volumes in the left hippocampus, amygdala, and the right hippocampus than SLE patients without cognitive deficits. CONCLUSION SLE patients with cognitive deficits appeared to have reduced temporal lobe structures when compared with SLE without cognitive deficits. These results corroborate a systems vulnerability model that investigated temporal lobe vulnerability during normal aging and in other neurological disorders.
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Affiliation(s)
- Nicolle Zimmermann
- Department of Radiology, Federal University of Rio de Janeiro, Brigadeiro Trompowsky Avenue, Clementino Fraga Filho University Hospital, Room SSN29, 21941-590, Rio de Janeiro, Brazil.
| | - Diogo Goulart Corrêa
- Department of Radiology, Federal University of Rio de Janeiro, Brigadeiro Trompowsky Avenue, Clementino Fraga Filho University Hospital, Room SSN29, 21941-590, Rio de Janeiro, Brazil.,Department of Medical Physics, Diagnósticos da America S.A., DASA, 4666 das Américas Avenue, Barra da Tijuca, 22640-102, Rio de Janeiro, Brazil
| | - Tadeu Almodovar Kubo
- Department of Medical Physics, Diagnósticos da America S.A., DASA, 4666 das Américas Avenue, Barra da Tijuca, 22640-102, Rio de Janeiro, Brazil
| | - Tania Maria Netto
- Department of Radiology, Federal University of Rio de Janeiro, Brigadeiro Trompowsky Avenue, Clementino Fraga Filho University Hospital, Room SSN29, 21941-590, Rio de Janeiro, Brazil
| | - Denis Batista Pereira
- Department of Radiology, Federal University of Rio de Janeiro, Brigadeiro Trompowsky Avenue, Clementino Fraga Filho University Hospital, Room SSN29, 21941-590, Rio de Janeiro, Brazil
| | - Rochele Paz Fonseca
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, 6681 Ipiranga Avenue, Building 11, Partenon, 90619-900, Porto Alegre, RS, Brazil
| | - Emerson Leandro Gasparetto
- Department of Radiology, Federal University of Rio de Janeiro, Brigadeiro Trompowsky Avenue, Clementino Fraga Filho University Hospital, Room SSN29, 21941-590, Rio de Janeiro, Brazil.,Department of Medical Physics, Diagnósticos da America S.A., DASA, 4666 das Américas Avenue, Barra da Tijuca, 22640-102, Rio de Janeiro, Brazil
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Robazzi TCM, Alves C, Abreu L, Lemos G. Coexistência de lúpus eritematoso sistêmico e doença falciforme: relato de caso e revisão da literatura. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:68-74. [DOI: 10.1016/j.rbr.2013.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 02/26/2013] [Accepted: 05/14/2013] [Indexed: 10/24/2022] Open
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Abstract
This systematic review described the criteria and main evaluations methods procedures used to classify neuropsychiatric systemic lupus erythematosus (NPSLE) patients. Also, within the evaluations methods, this review aimed to identify the main contributions of neuropsychological measurements in neuroimaging studies. A search was conducted in PubMed, EMBASE and SCOPUS databases with the terms related to neuropsychiatric syndromes, systemic lupus erythematosus, and neuroimaging techniques. Sixty-six abstracts were found; only 20 were completely analyzed and included. Results indicated that the 1999 American College of Rheumatology (ACR) criteria is the most used to classify NPSLE samples together with laboratorial, cognitive, neurological and psychiatric assessment procedures. However, the recommended ACR assessment procedures to classify NPSLE patients are being used incompletely, especially the neuropsychological batteries. Neuropsychological instruments and neuroimaging techniques have been used mostly to characterize NPSLE samples, instead of contributing to their classifications. The most described syndromes in neuroimaging studies have been seizure/cerebrovascular disease followed by cognitive dysfunctions as well as headache disorder.
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Sciascia S, Bertolaccini ML, Roccatello D, Khamashta MA, Sanna G. Autoantibodies involved in neuropsychiatric manifestations associated with systemic lupus erythematosus: a systematic review. J Neurol 2014; 261:1706-14. [DOI: 10.1007/s00415-014-7406-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/05/2014] [Accepted: 06/06/2014] [Indexed: 11/28/2022]
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Gaber W, Ezzat Y, El Fayoumy NM, Helmy H, Mohey AM. Detection of asymptomatic cranial neuropathies in patients with systemic lupus erythematosus and their relation to antiribosomal P antibody levels and disease activity. Clin Rheumatol 2014; 33:1459-66. [DOI: 10.1007/s10067-014-2679-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/27/2014] [Accepted: 04/27/2014] [Indexed: 11/29/2022]
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Streifler JY, Molad Y. Connective tissue disorders: systemic lupus erythematosus, Sjögren's syndrome, and scleroderma. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:463-473. [PMID: 24365313 DOI: 10.1016/b978-0-7020-4086-3.00030-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Connective tissue disorders are systemic, autoimmune, multiorgan diseases in which the central and peripheral nervous systems are frequently involved. The objective of this chapter is to describe the neurological manifestations of three of the most common systemic autoimmune disorders: systemic lupus erythematosus (SLE), scleroderma, and Sjögren's syndrome (SS). In SLE the neuropsychiatric manifestations involve mainly the central nervous system (CNS), including cognitive dysfunction, headache, psychosis and mood changes, seizures, cerebrovascular disease, and myelopathy. Peripheral nervous system (PNS) manifestations are less common and include polyneuropathies as well as mononeuropathies and acute inflammatory demyelinating polyneuropathy. Antiphospholipid syndrome (APLS) is relatively common and should be searched for whenever focal neurological symptoms occur. In scleroderma the PNS is more commonly involved; symptoms include polyneuropathies, entrapment neuropathies, and mononeuropathies (mostly cranial neuropathies or mononeuritis multiplex). Additionally autonomic involvement occurs and myopathies are relatively common. In SS the PNS is similarly involved with several types of polyneuropathies, mononeuropathies, and autonomic dysfunction. Also common are myelopathies and aseptic meningitides. These and other, less common manifestations, as well as the diagnostic procedures and the therapeutic approaches, will be dealt with in this chapter.
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Affiliation(s)
- Jonathan Y Streifler
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv and Neurology Unit, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel.
| | - Yair Molad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv and Rheumatology Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
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Sisterolli-Diniz D, Oliveira AD, Paula DSD, Rodrigues RV, Silva NAD. Functional impairments in white matter syndrome of neuropsychiatric systemic lupus erythematosus are similar to those observed in patients with multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 70:769-73. [PMID: 23060102 DOI: 10.1590/s0004-282x2012001000004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 07/17/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE In order to compare white matter syndrome of neuropsychiatric systemic lupus erythematosus (NPSLE) and multiple sclerosis (MS), an assessment on demographic, medical history, and clinical data was proposed. METHODS Sixty-four patients with NPSLE and 178 with MS answered a questionnaire and were evaluated regarding functional system, expanded disability status scale (EDSS), Beck depression inventory (BDI), and Beck anxiety inventory (BAI). RESULTS The prevalence of autoimmune diseases and altered consciousness was similar in both groups, however it was higher than in the general population. Systemic signs and symptoms occurred from 2.9 to 61.9% of the MS cases, while neurological signs and symptoms occurred in 9.4 to 76.4% of the NPSLE ones. The motor, visual, and mental systems were the most affected in both diseases. The BDI in NPSLE had higher scores and the BAI in MS. CONCLUSIONS The functional impairments in NPSLE were similar to those of MS, although greater impairment of the functional systems of cerebellar, sensitivity, and sphincters occurred in MS cases, and greater symptoms of depression, anxiety, and headache also occurred in it.
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Affiliation(s)
- Denise Sisterolli-Diniz
- Department of Neurology, Medical School of Universidade Federal de Goiás (UFG), Goiânia GO, Brazil.
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Uguz F, Kucuk A, Cicek E, Kayhan F, Tunc R. Mood, anxiety and personality disorders in patients with systemic lupus erythematosus. Compr Psychiatry 2013; 54:341-5. [PMID: 23246099 DOI: 10.1016/j.comppsych.2012.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 09/24/2012] [Accepted: 10/02/2012] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study presents the current prevalence of mood, anxiety and personality disorders and factors associated with the existence of psychiatric disorders in patients with systemic lupus erythematosus (SLE). METHODS The study sample was comprised of 45 patients with SLE and 60 control subjects. Mood and anxiety disorders were ascertained by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version. Personality disorders were diagnosed with the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders. The disease activity was assessed with SLE Disease Activity Index. RESULTS Of the 45 patients, 21 (46.7%) had at least one mood or anxiety disorder, and 16 (35.6%) had at least one personality disorder. The most common Axis I and Axis II diagnoses in the patient group were major depression (22.2%) and obsessive-compulsive personality disorder (20.0%), respectively. Specifically, major depression, generalized anxiety disorder and obsessive-compulsive personality disorder were more prevalent in the SLE group compared to the control group. The existence of Axis I disorders was associated with a more severe disease activity of SLE. CONCLUSION Mood and anxiety disorders, particularly major depression and generalized anxiety disorder, are frequently observed in patients with SLE.
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Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey.
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Cranial Nerve Palsies: Sarcoidosis to Systemic Lupus Erythematosus. Case Rep Rheumatol 2013; 2013:175261. [PMID: 23401835 PMCID: PMC3564269 DOI: 10.1155/2013/175261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/03/2013] [Indexed: 11/18/2022] Open
Abstract
Cranial palsies are a very rare feature of SLE. Similarly, peripheral sensory-motor axonal neuropathy is very uncommon in SLE. The combination of the two as the presenting symptoms of SLE is a diagnostic challenge particularly in an elderly male patient with a known diagnosis of sarcoidosis. This case serves to highlight the diagnostic considerations in such a patient. The lack of response to standard therapy and the presence of subtle clues like anemia, proteinuria, and mild serositis should prompt the physician to look for alternate diagnoses. The potential association of SLE and sarcoidosis is also discussed. SLE can be present in elderly male patients with cranial and peripheral neuropathy.
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Abstract
INTRODUCTION The frequency of neuropsychiatric symptoms in systemic lupus varies between 14 and 75%. Their mechanisms are multiple and their non-specificity makes the etiological diagnosis more difficult. The MRI lesions are dominated by small white matter hyperintensities. CASE REPORT We report a case of 17-year-old girl without medical, surgical or familial past, who presented an acute psychotic episode with fever. The neurological examination showed a pyramidal syndrome. The brain MRI objectified diffuse, bilateral and symmetrical white and gray matter hyperintensities. The diagnosis of neuropsychiatric lupus was retained with association of more than four criteria among the 11 ARA revised criteria: pleural effusion, neuropsychiatric manifestations, anemia, lymphopenia and positive ANA. The treatment was based on corticosteroids. The evolution was fatal. DISCUSSION Psychiatric disorders are polymorphic and appear during the course of the disease or at diagnosis; they can be seen in 20% of cases and are a sign of a poor prognosis. Most often these disorders are a non-specific reaction, but severe clinical forms can be observed as suicidal risk or mood disorders (depression, mania...), or acute psychotic episode. CONCLUSION The diagnosis of neuropsychiatric lupus must be evoked systematically in atypical neuropsychiatric disorders especially when confronted with minimal biological and brain imaging abnormalities.
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Cognitive and Emotional Abnormalities in Systemic Lupus Erythematosus: Evidence for Amygdala Dysfunction. Neuropsychol Rev 2012; 22:252-70. [DOI: 10.1007/s11065-012-9213-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/27/2012] [Indexed: 12/23/2022]
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Lorenzoni PJ, Scola RH, Kay CS, Novak FT, Cardoso EH, Scalcon MR, Rachid Filho A, Werneck LC. Isolated hypoglossal nerve palsy: an unusual rare presentation in systemic lupus erythematosus. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:843-4. [DOI: 10.1590/s0004-282x2011000600025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vogel A, Bhattacharya S, Larsen JL, Jacobsen S. Do subjective cognitive complaints correlate with cognitive impairment in systemic lupus erythematosus? A Danish outpatient study. Lupus 2011; 20:35-43. [PMID: 21233148 DOI: 10.1177/0961203310382430] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the prevalence of cognitive impairment and its association with depressive symptoms and self-reported cognitive complaints in Danish outpatients with systemic lupus erythematosus (SLE). Fifty-seven consecutive female SLE-outpatients were examined with a comprehensive neuropsychological test-battery, a 20-item self-administered Perceived Deficits Questionnaire (PDQ) and a self-rated depression scale (Major Depression Inventory). Twenty-two patients (38.5%) were classified as cognitively impaired, mostly with deficits in executive functions and attention. Among cognitively impaired patients only 18.2% had significantly higher PDQ scores than the normal range. PDQ scores were highly correlated to depressive symptoms (r = 0.67, p < 0.001). Only two neuropsychological tests were significantly correlated with subjective cognitive complaints. When these variables and self-rated depression score were entered into a regression model both depression score and Symbol Digit Modalities Test performances were significantly associated with the PDQ score. In conclusion, cognitive impairments were common in this group of (mild) SLE outpatients, but the level of significant subjective cognitive complaints was low even among patients with cognitive impairment. Affective status may influence subjective experience of cognitive functions even more than cognitive functioning itself, and absence of subjective cognitive complaints did not exclude the presence of cognitive impairments.
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Affiliation(s)
- A Vogel
- Memory Disorders Research Group, Department of Neurology, Neuroscience Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Saleh Z, Menassa J, Abbas O, Atweh S, Arayssi T. Cranial nerve VI palsy as a rare initial presentation of systemic lupus erythematosus: case report and review of the literature. Lupus 2009; 19:201-5. [DOI: 10.1177/0961203309345722] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 48-year-old woman presented with isolated sixth cranial nerve palsy. She subsequently developed systemic lupus erythematosus (SLE) based on clinical and laboratory parameters. Three years later, she presented again with sixth cranial nerve palsy affecting the contralateral eye. Within 2 weeks of steroid initiation, complete recovery occurred. The unusual rare presentation of SLE in the current patient, as well as the pathogenesis and treatment of cranial neuropathy in SLE are discussed. Lupus (2010) 19, 201—205.
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Affiliation(s)
- Z. Saleh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - J. Menassa
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - O. Abbas
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - S. Atweh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - T. Arayssi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon,
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Cikes N, Bosnic D, Sentic M. Non-MS autoimmune demyelination. Clin Neurol Neurosurg 2008; 110:905-12. [PMID: 18928881 DOI: 10.1016/j.clineuro.2008.06.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 06/05/2008] [Indexed: 11/15/2022]
Abstract
Connective tissue diseases can be characterised by central nervous system (CNS) involvement, in some patients manifested by demyelination areas in the white matter of the brain and spinal cord, which are difficult to differentiate from multiple sclerosis (MS) and other demyelinating processes, such as transverse myelitis and optic neuritis. Demyelinating process may be the feature of nervous impairment in systemic lupus erythematosus, Behcet's disease (BD), Sjoegren's syndrome (SS), systemic sclerosis (SSc) or very rarely other systemic autoimmune diseases. An acute isolated neurological syndrome, as the most common symptom of MS can sometimes be the only feature or even first manifestation of nervous impairment in connective tissue disease, hence presenting the diagnostic problem. Although the white matter abnormalities seen by magnetic resonance imaging may be similar in non-MS autoimmune demyelination and MS, it is the most important diagnostic tool in the differential diagnosis of the mentioned conditions. Investigating the presence of various autoantibodies potentially involved in the pathogenesis of demyelinating lesions as well as cerebrospinal fluid (CSF) analysis can be helpful.
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Affiliation(s)
- Nada Cikes
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia.
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Mondal TK, Saha SK, Miller VM, Seegal RF, Lawrence DA. Autoantibody-mediated neuroinflammation: pathogenesis of neuropsychiatric systemic lupus erythematosus in the NZM88 murine model. Brain Behav Immun 2008; 22:949-59. [PMID: 18411022 DOI: 10.1016/j.bbi.2008.01.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Revised: 01/21/2008] [Accepted: 01/21/2008] [Indexed: 10/22/2022] Open
Abstract
Autoantibodies play an important role in central nervous system manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE). Previous studies have shown that the lupus-prone NZM88 strain has major neural deficits and high titers of serum IgG to brain antigens. ELISA was performed to detect the presence of IgG in different brain regions of NZM88 mice and to compare the levels with NZM2758 mice and control strains (NZW and BALB/c). There was a substantial increase of IgG in the substantia nigra (SN) and hypothalamus (HT) of brains from NZM88 mice compared to control NZW and BALB/c mice, whereas NZM2758 mice had more IgG in the cortex. The increased presence of IgG in the NPSLE-prone NZM88 mouse brain was paralleled by increased TNF-alpha and IL-12 in the SN and HT regions; significantly elevated expression of MHC Class-II was also observed in the SN of NZM88 mice and cortex of NZM2758 mice. A co-culture system of dopaminergic neurons and microglia was used to demonstrate that NZM88 sera modifies dopaminergic cell activity only in the presence of microglia and that TNF-alpha is synthesized and released in this co-culture. This study demonstrates a functional link between the autoantibodies, the activation of microglia, and neuronal function associated dopamine production, which is suggested to be causally related to the predominant NPSLE syndromes.
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Affiliation(s)
- Tapan K Mondal
- Biggs Laboratory, Wadsworth Center, New York State Department of Health, Empire State Plaza, Albany, NY 12201-0509, USA
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Michon J, Boutémy J, Artigues N, Damon A, Daubin C, Zoulim A, Ollivier Y, Constant J, Letellier P, Bienvenu B. Traitement tardif d’une forme sévère de neurolupus. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sugimoto T, Takeda N, Yamakawa I, Kawai H, Tanaka Y, Sakaguchi M, Osawa N, Uzu T, Kashiwagi A. Intractable hiccup associated with aseptic meningitis in a patient with systemic lupus erythematosus. Lupus 2008; 17:152-3. [PMID: 18250141 DOI: 10.1177/0961203307085253] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
BACKGROUND AND OBJECTIVE Recent studies suggest that a substantial number of patients with autoimmune limbic encephalitis may improve if properly diagnosed and treated. This is due, in part, to the increasing recognition of disorders that associate with antibodies to neuronal cell membrane antigens. This review focuses in these disorders, framed in a clinically useful immunologic classification of limbic encephalitis. REVIEW SUMMARY Patients with limbic encephalitis usually present with rapidly progressive short-term memory deficits, psychiatric symptoms, and seizures. After excluding viral and systemic autoimmune disorders, many patients with limbic encephalitis (paraneoplastic or not) have cerebrospinal fluid inflammatory findings, EEG or MRI abnormalities in the temporal lobes, and antineuronal antibodies. These antibodies are directed against 2 broad categories of antigens: (1) intracellular or classic paraneoplastic antigens, including Hu, Ma2, CV2/CRMP5, and amphiphysin among others, and (2) cell membrane antigens, including voltage-gated potassium channels, N-methyl-D-aspartate receptor, and others expressed in the neuropil of hippocampus and cerebellum (pending characterization). Whereas the disorders related to the first category of antibodies associate with cancer (lung, testis and other), prominent brain infiltrates of cytotoxic T-cells, and limited response to treatment, the disorders related to the second category of antibodies associate less frequently with cancer (thymoma, teratoma), seem to be antibody-mediated, and respond significantly better to immunotherapy. CONCLUSIONS Once considered an extremely rare disorder, almost always related to cancer, and refractory to treatment, limbic encephalitis is now regarded as a relatively frequent disorder, often unrelated to cancer, and with clinical-immunologic variants that respond to treatment.
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Affiliation(s)
- Erdem Tüzün
- Division of Neuro-Oncology, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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