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Tatsukawa H, Ishii K, Haranaka M, Kumagi M, Hino I, Yoshimatsu H. Evaluation of average amount of cerebral blood flow measured by brain perfusion index in patients with neuropsychiatric systemic lupus erythematosus. Lupus 2016; 14:445-9. [PMID: 16038108 DOI: 10.1191/0961203305lu2127oa] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We used the brain perfusion index (BPI), an indicator of the average amount of cerebral blood flow (CBF), to evaluate the usefulness of the average amount of CBF for neuropsychiatric systemic lupus erythematosus (NPSLE). Of the seventy three SLE patients examined in this study (total 100 scans), 16 patients (23 scans) had already been diagnosed with NPSLE based on clinical symptoms indicative of central nervous system involvement. In addition, 12 patients (17 scans) exhibited the antiphospholipid antibody syndrome (APS). BPI is significantly influenced by age and we therefore used the BPI ratio (ratio of age predicted BPI to measured BPI value) for each assessment. The mean BPI value of 100 scans was 11.2 + 2.79, and the mean BPI ratio was 0.99 + 0.24 in all SLE patients. The mean BPI ratio among NPSLE (0.84 + 0.19) was significantly lower than that of the non-NPSLE patients (1.04 + 0.24) (P, 0.0005). However, there was no difference in the mean BPI ratio between APS patients (0.98 + 0.24) and non-APS patients (0.99 + 0.25). These results indicate that the mean CBF assessed by the BPI ratio using SPECT is of use in the evaluation of central nervous system involvement in SLE patients.
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Affiliation(s)
- H Tatsukawa
- Department of Internal Medicine I, Faculty of Medicine, Oita University, Oita, Japan.
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Medina G, Molina-Carrión LE, Angeles-Garay U, Vera-Lastra O, Arias-Flores R, Romero-Sánchez G, Jara LJ. Cerebral blood flow abnormalities in neurologically asymptomatic patients with primary antiphospholipid syndrome. Lupus 2012; 21:642-8. [DOI: 10.1177/0961203312436853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate cerebral blood flow abnormalities in primary antiphospholipid syndrome (PAPS) patients without ongoing neurological manifestations. Patients and methods: We included 28 PAPS patients and 28 healthy controls. Carotid Doppler ultrasound, and echocardiographic evaluation were done. Transcranial Doppler ultrasonography measured mean flow velocity (MFV) in the carotid siphon, middle, anterior, posterior, intracranial vertebral arteries, and basilar artery (11 cerebral arteries). Results were considered abnormal when the MFV was out of the normal range according to age and/or flow asymmetry and/or more than four arterial segments affected. Results: The mean age of patients was 41.4 ± 11.2 and 39.3 ± 8.6 years in controls. Disease duration was 11 ± 2.7 years. A significant increase in MFV in 7/11 cerebral arteries in PAPS patients, mainly in the middle and anterior cerebral arteries was found compared with controls. A significant association between lupus anticoagulant, history of stroke and obesity with a greater number of affected arteries was found. We did not find an association between MFV and abnormal echocardiography, arterial hypertension and carotid intima-media thickness. Conclusions: Asymptomatic patients with PAPS can have significantly increased MFVs. These alterations may be the consequence of accelerated atherosclerosis, PAPS vasculopathy or both. Whatever the cause, these findings can represent a risk for stroke in PAPS patients that needs the trial of other therapeutic options.
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Affiliation(s)
- G Medina
- Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS,Mexico City, Mexico; 2Universidad Nacional Autónoma de México, Mexico City, Mexico; 3Neurology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 4Epidemiology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 5Internal Medicine Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; and 6Direction of Education and
| | - LE Molina-Carrión
- Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS,Mexico City, Mexico; 2Universidad Nacional Autónoma de México, Mexico City, Mexico; 3Neurology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 4Epidemiology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 5Internal Medicine Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; and 6Direction of Education and
| | - U Angeles-Garay
- Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS,Mexico City, Mexico; 2Universidad Nacional Autónoma de México, Mexico City, Mexico; 3Neurology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 4Epidemiology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 5Internal Medicine Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; and 6Direction of Education and
| | - O Vera-Lastra
- Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS,Mexico City, Mexico; 2Universidad Nacional Autónoma de México, Mexico City, Mexico; 3Neurology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 4Epidemiology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 5Internal Medicine Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; and 6Direction of Education and
| | - R Arias-Flores
- Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS,Mexico City, Mexico; 2Universidad Nacional Autónoma de México, Mexico City, Mexico; 3Neurology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 4Epidemiology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 5Internal Medicine Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; and 6Direction of Education and
| | - G Romero-Sánchez
- Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS,Mexico City, Mexico; 2Universidad Nacional Autónoma de México, Mexico City, Mexico; 3Neurology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 4Epidemiology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 5Internal Medicine Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; and 6Direction of Education and
| | - LJ Jara
- Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS,Mexico City, Mexico; 2Universidad Nacional Autónoma de México, Mexico City, Mexico; 3Neurology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 4Epidemiology Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; 5Internal Medicine Department, Hospital de Especialidades Centro Médico La Raza, IMSS, Mexico City, Mexico; and 6Direction of Education and
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Chen JJH, Wang JY, Chang YM, Su SY, Chang CT, Sun SS, Kao CH, Lee CC. Regional cerebral blood flow between primary and concomitant fibromyalgia patients: a possible way to differentiate concomitant fibromyalgia from the primary disease. Scand J Rheumatol 2007; 36:226-32. [PMID: 17657679 DOI: 10.1080/03009740601153790] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Technetium-99m ethyl cysteinate dimer (Tc-99m ECD) brain single photon emission computed tomography (SPECT) has been used to detect abnormal regional cerebral blood flow (rCBF) in women with primary fibromyalgia (FM). The main aim of this study was to investigate the rCBF deficit in concomitant FM patients and compare it with primary FM. METHODS An observational study was designed to analyse the SPECT findings in 92 female patients recruited from January 2002 to January 2004. Differences in the rCBF hypoperfusive areas between 49 primary and 29 concomitant FM patients were assessed in different areas of the brain using the chi(2)-test for statistical significance. RESULTS Tc-99m ECD brain SPECT in 71 FM patients revealed heterogeneous rCBF in comparison to the homogeneous scan in 14 control patients. The most prominent rCBF hypoperfusive region in both primary and concomitant FM groups was the left temporoparietal area, followed by the thalamus, right temporoparietal, frontal, and basal ganglia areas. Differences in rCBF hypoperfusion in these areas for both FM groups were not significant (all p>0.5). CONCLUSIONS Reduced rCBF at cortical regions, in addition to previously reported areas at the thalamus and the subcortical nucleus, in FM patients was demonstrated in this study. The perfusion deficit areas were similar between primary and concomitant FM when the underlying disease activity was quiescent. The feasibility of using this neuroimaging study to differentiate FM from the primary disease, such as rheumatoid arthritis (RA)-associated depression and neuropsychiatric lupus, should be considered.
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Affiliation(s)
- J J H Chen
- Section of Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
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Sanna G, D'Cruz D, Cuadrado MJ. Cerebral Manifestations in the Antiphospholipid (Hughes) Syndrome. Rheum Dis Clin North Am 2006; 32:465-90. [PMID: 16880079 DOI: 10.1016/j.rdc.2006.05.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The importance of cerebral disease in patients with the Hughes syndrome is now becoming more widely recognized. The range of neuropsychiatric manifestations of APS is comprehensive, and includes focal symptoms attributable to lesions in a specific area of the brain as well as diffuse or global dysfunction. Patients with APS frequently present with strokes and TIA, but a wide spectrum of other neurologic features-also including non thrombotic neurologic syndromes-has been described in association with the presence of aPL. The recognition of APS has had a profound impact on the understanding and management of the treatment of CNS manifestations associated with connective tissue diseases, in particular, SLE. Many patients with focal neurologic manifestations and aPL, who a few years ago would have received high-dose corticosteroids or immunosuppression, are often successfully treated with anticoagulation. In our opinion, testing for aPL may have a major diagnostic and therapeutic impact not only in patients with autoimmune diseases and neuropsychiatric manifestations, but also in young individuals who develop cerebral ischemia, in those with atypical multiple sclerosis, transverse myelitis, and atypical seizures. We would also recommend testing for aPL for young individuals found with multiple hyperintensity lesions on brain MRI in the absence of other possible causes,especially when under the age of 40 years. It is our practice to anticoagulate patients with aPL suffering from cerebral ischemia with a target INR of 3.0 to prevent recurrences. Low-dose aspirin alone (with occasional exceptions)does not seem helpful to prevent recurrent thrombosis in these patients. Our recommendation, once the patient has had a proven thrombosis associated with aPL, is long-term (possibly life-long) warfarin therapy. Oral anti coagulation carries a risk of hemorrhage, but in our experience the risk of serious bleeding in patients with APS and previous thrombosis treated with oral anticoagulation to a target INR of 3.5 was similar to that in groups of patients treated with lower target ratios. Although a double-blind crossover trial comparing low molecular weight heparin with placebo in patients with aPL and chronic headaches did not show a significant difference in the beneficial effect of low molecular weight heparin versus placebo, in our experience selected patients with aPL and neuropsychiatric manifestations such as seizures, severe cognitive dys-function, and intractable headaches unresponsive to conventional treatment may respond to anticoagulant treatment. The neurologic ramifications of Hughes syndrome are extensive, and it behoves clinicians in all specialties to be aware of this syndrome because treatment with anticoagulation may profoundly change the outlook for these patients.
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Affiliation(s)
- Giovanni Sanna
- Department of Rheumatology, Homerton University Hospital, London E9 6SR, United Kingdom.
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Zettinig G, Asenbaum S, Fueger BJ, Hofmann A, Diemling M, Mittlboeck M, Dudczak R. Increased prevalence of sublinical brain perfusion abnormalities in patients with autoimmune thyroiditis: evidence of Hashimoto's encephalitis? Clin Endocrinol (Oxf) 2003; 59:637-43. [PMID: 14616889 DOI: 10.1046/j.1365-2265.2003.01901.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Hashimoto's encephalitis is a term which describes encephalopathy associated with autoimmune thyroiditis, but it is not based on evidence, whether Hashimoto's encephalitis is a distinct clinical entity by itself. In previously reported cases of Hashimoto's encephalitis, abnormal brain perfusion studies have been reported. The aim of this study was to evaluate the prevalence of brain perfusion abnormalities in euthyroid patients with autoimmune thyroiditis. METHODS 99mTc Ethyl cystein dimer (ECD) single photon emission computed tomography (SPECT) studies were performed in a study group of 41 euthyroid patients with autoimmune thyroiditis and a matched control group of 35 healthy individuals. All study participants had a normal neurological investigation and a detailed neurological history taking. Individuals with known or suspected morphological brain abnormalities were excluded from the study. Zung's Self-Rating Anxiety Scale (SAS) and Zung's Self-Rating Depression Scale (SDS) were used to detect depression and mood disorders. Automatic quantification of perfusion was performed with both a voxel-based analysis as well as a volume-of-interest (VOI) based analysis of 46 predefined cortical and subcortical regions. The findings from both groups were compared to a reference template. RESULTS In the voxel-based analysis, there was a significant difference between patients and controls in the mean volume of perfusion defects deviating 2SD below the normal values (21.8 ml vs. 10.4 ml; P = 0.02). Hyperperfused areas, however, did not differ significantly between study patients and controls. A significant correlation of the perfusion defects with time since diagnosis of autoimmune thyroiditis was seen (r = 0.42). In the VOI-based analysis, abnormal regions were more frequent in the study group when compared to controls (P < 0.01) However, no topographic pattern was apparent. Regarding neurological findings, no significant difference was found between study patients and controls. However, both the SAS and SDS scores differed significantly between the two groups, but there was neither a correlation between the two scores and perfusion abnormalities nor an association with depression in our study group. CONCLUSIONS These findings of impaired brain perfusion in patients with autoimmune thyroiditis further strengthen the hypothesis of a possible cerebral involvement in autoimmune thyroiditis in individual cases. The presence of cerebral hypoperfusion suggests a cerebral vasculitis as the most likely pathogenetic model.
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Affiliation(s)
- Georg Zettinig
- Department of Nuclear Medicine, University of Vienna, Austria.
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