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The Diversity of Neurologic Events in Systemic Lupus Erythematosus: Prospective Clinical and Computed Tomographic Classification of 82 Events in 71 Patients

The Diversity of Neurologic Events in Systemic Lupus Erythematosus: Prospective Clinical and... Abstract • To investigate outcome and pathophysiology of central nervous system (CNS) systemic lupus erythematosus (SLE), we prospectively codified all cases of CNS SLE. Eighty-two events occurred in 71 patients. Four events in four patients were due to infection and were excluded. Twelve events occurred in 11 women with positive antinuclear antibody but negative anti-DNA antibody test reactions and no other manifestation of SLE. Of the remaining 66 events (56 patients), 26 events were "isolated" and 40 "complex." Non-CNS SLE was "active" during 47 events and "inactive" during 19 events. "Isolated" CNS events were equally likely in clinically "active" and "inactive" SLE. Patients with active SLE were as likely to have an episodic or remittent course as were patients with inactive SLE. "Complex" events, however, were more likely to have favorable outcome than were "isolated" events. "Isolated" events without focal CT abnormalities, the only component of CNS SLE that can be called diffuse lupus encephalitis, accounted for only 20% of all neurologic events. References 1. Abel T, Gladman DD, Urowitz MB: Neuropsychiatric lupus . J Rheumatol 1980;7:325-333. 2. Feinglass EJ, Arnett FC, Dorsch CA, et al: Neuropsychiatric manifestations of systemic lupus erythematosus . Medicine 1976;55:323-339.Crossref 3. Gibson T, Myers AR: Nervous system involvement in systemic lupus erythematosus . Ann Rheum Dis 1976;35:398-405.Crossref 4. Grigor R, Edmonds J, Lewkonia R, et al: Systemic lupus erythematosus: A prospective analysis . Ann Rheum Dis 1978;37:121-128.Crossref 5. Sergent JS, Lockshin MD, Klempner MS, et al: Central nervous system disease in systemic lupus erythematosus . Am J Med 1975;58:644-654.Crossref 6. Small P, Mass MF, Kohler PF, et al: Central nervous system involvement in SLE . Arthritis Rheum 1977;20:869-878.Crossref 7. Appenzeller O, Williams RC: Cerebral lupus erythematosus . Ann Intern Med 1979;90:430-431.Crossref 8. Atkins CJM, Kondon JJ, Quismorio FP, et al: The choroid plexus in systemic lupus erythematosus . Ann Intern Med 1972;76:65-72.Crossref 9. Bluestein HG, Williams GW, Steinberg AD: Cerebrospinal fluid antibodies to neuronal cells: Association with neuropsychiatric manifestations of systemic lupus erythematosus . Am J Med 1981;70:239-246.Crossref 10. Bluestein HG, Woods VL: Antineuronal antibodies in systemic lupus erythematosus . Arthritis Rheum 1982;25:773-778.Crossref 11. Boyer RS, Sun NCJ, Verity A, et al: Immunoperoxidase staining of the choroid plexus in systemic lupus erythematosus . J Rheumatol 1980;7:645-650. 12. Bresnihan B, Hohmeister R, Cutting J, et al: The neuropsychiatric disorder in systemic lupus erythematosus: Evidence for both vascular and immune mechanisms . Ann Rheum Dis 1979;38:301-306.Crossref 13. Bresnihan B, Oliver M, Grigor R, et al: Brain-reactive lymphocytotoxic antibodies in systemic lupus erythematosus with and without cerebral involvement . Clin Exp Immunol 1977;30:330-337. 14. Harbeck RJ, Hoffman AA, Hoffman SA, et al: Cerebrospinal fluid and the choroid plexus during acute immune complex disease . Clin Immunol Immunopathol 1979;13:413-425.Crossref 15. Herrera R, Guzman L, Avalos E, et al: Serologic studies in neuropsychiatric (NP) systemic lupus erythematosus (SLE), abstracted . Arthritis Rheum 1982;25:57. 16. Hoffman SA, Shucard DW, Harbeck RJ: Chronic immune complex disease: Behavioural and immunological correlates . J Neuropathol Exp Neurol 1978;37:426-435.Crossref 17. Kassan SS, Kagen LJ: Elevated levels of cerebrospinal fluid guanosine 3',5'-cyclic monophosphate (c-GMP) in systemic lupus erythematosus . Am J Med 1978;64:732-741.Crossref 18. Kassan SS, Kagen LJ: Central nervous system lupus erythematosus . Arthritis Rheum 1979;22:449-457.Crossref 19. Lampert PA, Oldstone MBA: Host immunoglobulin G and complement deposits in the choroid plexus during spontaneous immune complex disease . Science 1979;205:1163-1164.Crossref 20. McIntosh RM, Koss MM: The choroid plexus: Immunologic injury and disease . Ann Intern Med 1974;81:111-112.Crossref 21. Pinching AJ, Travers RL, Hughes GRV: Oxygen-15 brain scanning for detection of cerebral involvement in systemic lupus erythematosus . Lancet 1978;1:898-900.Crossref 22. Quismorio FP, Friou GJ: Antibodies reactive with neurons in SLE patients with neuropsychiatric manifestations . Int Arch Allergy 1972;43:740-748.Crossref 23. Seibold JR, Buckingham RB, Medsger TA, et al: Cerebrospinal fluid immune complexes in systemic lupus erythematosus involving the central nervous system . Semin Arthritis Rheum 1982;12:68-76.Crossref 24. Steinman CR: Circulating DNA in systemic lupus erythematosus . Am J Med 1979;67:429-434.Crossref 25. Stewart G, Basten A: Lupus erythematosus and brain scanning . Ann Intern Med 1975;83:733-734.Crossref 26. Tan RF, Gladman DD, Urowitz MB, et al: Brain scan diagnosis of central nervous system involvement in systemic lupus erythematosus . Ann Rheum Dis 1978;37:357-362.Crossref 27. Williams GW, Bluestein HG, Steinberg AD: Brain-reactive lymphocytotoxic antibody in the cerebrospinal fluid of patients with systemic lupus erythematosus . Clin Immunol Immunopathol 1981;18:126-132.Crossref 28. Wilson HA, Winfield JB, Lahita RG, et al: Association of IgG anti-brain antibodies with central nervous system dysfunction in systemic lupus erythematosus . Arthritis Rheum 1979;22:458-462.Crossref 29. Winfield JB, Shaw M, Silverman LM, et al: Intrathecal IgG synthesis and blood-brain barrier impairment in patients with systemic lupus erythematosus and central nervous system dysfunction . Am J Med 1983;74:837-844.Crossref 30. Yancey CL, Doughty RA, Athreya B: Central nervous system involvement in childhood systemic lupus erythematosus . Arthritis Rheum 1981;24:1389-1395.Crossref 31. Zvaifler NJ, Bluestein HG: The pathogenesis of central nervous system manifestations of systemic lupus erythematosus . Arthritis Rheum 1982;25:862-866.Crossref 32. Kassan SS, Lockshin MD: Central nervous system lupus erythematosus . Arthritis Rheum 1979;22:1382-1385.Crossref 33. Lockshin MD, Reinitz E, Druzin ML, et al: Lupus pregnancy: Case-control prospective study demonstrating absence of lupus exacerbation during or after pregnancy . Am J Med 1984;77:893-898.Crossref 34. Bernstein RM: Cerebral lupus: A peep into Pandora's box . J Rheumatol 1982;9:817-818. 35. Bernstein RM, Vermess M, Steiner RE, et al: Nuclear magnetic resonance imaging and focal lesions of the brain in SLE, abstracted . Arthritis Rheum 1983;26:33. 36. Betson J, Reza M, Winter J, et al: Steroids and apparent cerebral atrophy in computed tomography scans . J Comput Assist Tomogr 1978;2:16-23.Crossref 37. Bilaniuk LT, Patel S, Zimmerman RA: Computed tomography of systemic lupus erythematosus . Radiology 1977;124:119-121.Crossref 38. Carette S, Urowitz MB, Grossman EL, et al: Cranial computerized tomography (CT) in systemic lupus erythematosus central nervous system disease (CNS) . J Rheumatol 1982;9:855-859. 39. Gonzalez-Scarano F, Lisak RP, Bilaniuk LT, et al: Cranial computed tomography in the diagnosis of systemic lupus erythematosus . Ann Neurol 1978;5:158-165.Crossref 40. Killian PJ, Schnapf DJ, Lawless OJ: Computerized axial tomography of the central nervous system, abstracted . Arthritis Rheum 1979;22:628-629. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

The Diversity of Neurologic Events in Systemic Lupus Erythematosus: Prospective Clinical and Computed Tomographic Classification of 82 Events in 71 Patients

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1986.00520030063016
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Abstract

Abstract • To investigate outcome and pathophysiology of central nervous system (CNS) systemic lupus erythematosus (SLE), we prospectively codified all cases of CNS SLE. Eighty-two events occurred in 71 patients. Four events in four patients were due to infection and were excluded. Twelve events occurred in 11 women with positive antinuclear antibody but negative anti-DNA antibody test reactions and no other manifestation of SLE. Of the remaining 66 events (56 patients), 26 events were "isolated" and 40 "complex." Non-CNS SLE was "active" during 47 events and "inactive" during 19 events. "Isolated" CNS events were equally likely in clinically "active" and "inactive" SLE. Patients with active SLE were as likely to have an episodic or remittent course as were patients with inactive SLE. "Complex" events, however, were more likely to have favorable outcome than were "isolated" events. "Isolated" events without focal CT abnormalities, the only component of CNS SLE that can be called diffuse lupus encephalitis, accounted for only 20% of all neurologic events. References 1. Abel T, Gladman DD, Urowitz MB: Neuropsychiatric lupus . J Rheumatol 1980;7:325-333. 2. Feinglass EJ, Arnett FC, Dorsch CA, et al: Neuropsychiatric manifestations of systemic lupus erythematosus . Medicine 1976;55:323-339.Crossref 3. Gibson T, Myers AR: Nervous system involvement in systemic lupus erythematosus . Ann Rheum Dis 1976;35:398-405.Crossref 4. Grigor R, Edmonds J, Lewkonia R, et al: Systemic lupus erythematosus: A prospective analysis . Ann Rheum Dis 1978;37:121-128.Crossref 5. Sergent JS, Lockshin MD, Klempner MS, et al: Central nervous system disease in systemic lupus erythematosus . Am J Med 1975;58:644-654.Crossref 6. Small P, Mass MF, Kohler PF, et al: Central nervous system involvement in SLE . Arthritis Rheum 1977;20:869-878.Crossref 7. Appenzeller O, Williams RC: Cerebral lupus erythematosus . Ann Intern Med 1979;90:430-431.Crossref 8. Atkins CJM, Kondon JJ, Quismorio FP, et al: The choroid plexus in systemic lupus erythematosus . Ann Intern Med 1972;76:65-72.Crossref 9. Bluestein HG, Williams GW, Steinberg AD: Cerebrospinal fluid antibodies to neuronal cells: Association with neuropsychiatric manifestations of systemic lupus erythematosus . Am J Med 1981;70:239-246.Crossref 10. Bluestein HG, Woods VL: Antineuronal antibodies in systemic lupus erythematosus . Arthritis Rheum 1982;25:773-778.Crossref 11. Boyer RS, Sun NCJ, Verity A, et al: Immunoperoxidase staining of the choroid plexus in systemic lupus erythematosus . J Rheumatol 1980;7:645-650. 12. Bresnihan B, Hohmeister R, Cutting J, et al: The neuropsychiatric disorder in systemic lupus erythematosus: Evidence for both vascular and immune mechanisms . Ann Rheum Dis 1979;38:301-306.Crossref 13. Bresnihan B, Oliver M, Grigor R, et al: Brain-reactive lymphocytotoxic antibodies in systemic lupus erythematosus with and without cerebral involvement . Clin Exp Immunol 1977;30:330-337. 14. Harbeck RJ, Hoffman AA, Hoffman SA, et al: Cerebrospinal fluid and the choroid plexus during acute immune complex disease . Clin Immunol Immunopathol 1979;13:413-425.Crossref 15. Herrera R, Guzman L, Avalos E, et al: Serologic studies in neuropsychiatric (NP) systemic lupus erythematosus (SLE), abstracted . Arthritis Rheum 1982;25:57. 16. Hoffman SA, Shucard DW, Harbeck RJ: Chronic immune complex disease: Behavioural and immunological correlates . J Neuropathol Exp Neurol 1978;37:426-435.Crossref 17. Kassan SS, Kagen LJ: Elevated levels of cerebrospinal fluid guanosine 3',5'-cyclic monophosphate (c-GMP) in systemic lupus erythematosus . Am J Med 1978;64:732-741.Crossref 18. Kassan SS, Kagen LJ: Central nervous system lupus erythematosus . Arthritis Rheum 1979;22:449-457.Crossref 19. Lampert PA, Oldstone MBA: Host immunoglobulin G and complement deposits in the choroid plexus during spontaneous immune complex disease . Science 1979;205:1163-1164.Crossref 20. McIntosh RM, Koss MM: The choroid plexus: Immunologic injury and disease . Ann Intern Med 1974;81:111-112.Crossref 21. Pinching AJ, Travers RL, Hughes GRV: Oxygen-15 brain scanning for detection of cerebral involvement in systemic lupus erythematosus . Lancet 1978;1:898-900.Crossref 22. Quismorio FP, Friou GJ: Antibodies reactive with neurons in SLE patients with neuropsychiatric manifestations . Int Arch Allergy 1972;43:740-748.Crossref 23. Seibold JR, Buckingham RB, Medsger TA, et al: Cerebrospinal fluid immune complexes in systemic lupus erythematosus involving the central nervous system . Semin Arthritis Rheum 1982;12:68-76.Crossref 24. Steinman CR: Circulating DNA in systemic lupus erythematosus . Am J Med 1979;67:429-434.Crossref 25. Stewart G, Basten A: Lupus erythematosus and brain scanning . Ann Intern Med 1975;83:733-734.Crossref 26. Tan RF, Gladman DD, Urowitz MB, et al: Brain scan diagnosis of central nervous system involvement in systemic lupus erythematosus . Ann Rheum Dis 1978;37:357-362.Crossref 27. Williams GW, Bluestein HG, Steinberg AD: Brain-reactive lymphocytotoxic antibody in the cerebrospinal fluid of patients with systemic lupus erythematosus . Clin Immunol Immunopathol 1981;18:126-132.Crossref 28. Wilson HA, Winfield JB, Lahita RG, et al: Association of IgG anti-brain antibodies with central nervous system dysfunction in systemic lupus erythematosus . Arthritis Rheum 1979;22:458-462.Crossref 29. Winfield JB, Shaw M, Silverman LM, et al: Intrathecal IgG synthesis and blood-brain barrier impairment in patients with systemic lupus erythematosus and central nervous system dysfunction . Am J Med 1983;74:837-844.Crossref 30. Yancey CL, Doughty RA, Athreya B: Central nervous system involvement in childhood systemic lupus erythematosus . Arthritis Rheum 1981;24:1389-1395.Crossref 31. Zvaifler NJ, Bluestein HG: The pathogenesis of central nervous system manifestations of systemic lupus erythematosus . Arthritis Rheum 1982;25:862-866.Crossref 32. Kassan SS, Lockshin MD: Central nervous system lupus erythematosus . Arthritis Rheum 1979;22:1382-1385.Crossref 33. Lockshin MD, Reinitz E, Druzin ML, et al: Lupus pregnancy: Case-control prospective study demonstrating absence of lupus exacerbation during or after pregnancy . Am J Med 1984;77:893-898.Crossref 34. Bernstein RM: Cerebral lupus: A peep into Pandora's box . J Rheumatol 1982;9:817-818. 35. Bernstein RM, Vermess M, Steiner RE, et al: Nuclear magnetic resonance imaging and focal lesions of the brain in SLE, abstracted . Arthritis Rheum 1983;26:33. 36. Betson J, Reza M, Winter J, et al: Steroids and apparent cerebral atrophy in computed tomography scans . J Comput Assist Tomogr 1978;2:16-23.Crossref 37. Bilaniuk LT, Patel S, Zimmerman RA: Computed tomography of systemic lupus erythematosus . Radiology 1977;124:119-121.Crossref 38. Carette S, Urowitz MB, Grossman EL, et al: Cranial computerized tomography (CT) in systemic lupus erythematosus central nervous system disease (CNS) . J Rheumatol 1982;9:855-859. 39. Gonzalez-Scarano F, Lisak RP, Bilaniuk LT, et al: Cranial computed tomography in the diagnosis of systemic lupus erythematosus . Ann Neurol 1978;5:158-165.Crossref 40. Killian PJ, Schnapf DJ, Lawless OJ: Computerized axial tomography of the central nervous system, abstracted . Arthritis Rheum 1979;22:628-629.

Journal

Archives of NeurologyAmerican Medical Association

Published: Mar 1, 1986

References