Spontaneous intracranial hemorrhage as an initial manifestation of primary Sjögren's syndrome: a case report

Neuroimaging Pearls from the MDS Congress Video Challenge. Part 2: Acquired Disorders

The MDS Video Challenge continues to be the one of most widely attended sessions at the International Congress. Although the primary focus of this event is the presentation of complex and challenging cases through videos, a number of cases over the years have also presented an unusual or important neuroimaging finding related to the case. We reviewed the previous Video Challenge cases and present here a selection of those cases which incorporated such imaging findings. We have compiled these "imaging pearls" into two anthologies. The first focuses on pearls where the underlying diagnosis was a genetic condition. This second anthology focuses on imaging pearls in cases where the underlying condition was acquired. For each case we present brief clinical details along with neuroimaging findings, the characteristic imaging findings of that disorder and, finally, the differential diagnosis for the imaging findings seen.

Postdural Puncture Headache and Acute Subdural Haematoma in Sjögren's Syndrome

Although spontaneous intracranial hypotension cases related to connective tissue diseases have been reported in the literature, to the best of our knowledge, no cases of iatrogenic intracranial hypotension have been described. In this paper, we plan to discuss a case of acute subdural haematoma and postdural puncture headache that developed after spinal anaesthesia in a patient with Sjögren's syndrome.

Neurological Complications of Rheumatic Disease

Rheumatic disease represents a broad spectrum of systemic conditions manifested by multisystem involvement and mediated by autoimmunity and inflammation. Their neurological complications may occur at any point in the disease process and are diagnostically challenging. For years central nervous system (CNS) was considered as a system uniquely protected from effects of the immune system because of the blood-brain barrier. Indeed, under physiological conditions immune access to CNS is tightly regulated. Over the past decade, new scientific discoveries highlighted pathways by which immune and neurological systems interact, including a variety of mechanisms controlling permeability of blood-brain barrier, and specific roles that CD4⁺ and CD8⁺ T-lymphocytes play in initiation of specific adaptive immune response to neural specific antigens. This leads to release of proinflammatory cytokines (interleukin 1, interleukin 6, and tumor necrosis factor alpha). In addition, B-cells involved in CNS inflammation produce antibodies against membrane bound and soluble antigens. This article describes specific neurological manifestations of the most common autoimmune rheumatic disorders.