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Chapter 1.3 - Vasculitis Secondary to Systemic Disease

from 1 - Inflammatory Conditions

Published online by Cambridge University Press:  06 October 2022

Anita Arsovska
Affiliation:
University of Ss Cyril and Methodius
Derya Uluduz
Affiliation:
Istanbul Üniversitesi
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Summary

SLE is an autoimmune chronic progressive disease which affects the central and peripheral nervous system and causes different neuropsychiatric symptoms. Neuropsychiatric Syndromes of Systemic Lupus Erythematosus (NPSLE) can be observed in 10-80% of SLE patients. NPLSE syndromes have been defined by America College of Rheumatology. Vascular and neuronal damage caused by inflammatory cytokines, autoantibodies and immune complexes are involved in pathogenesis of NPLSE. Stroke is the most severe complication of SLE and the incidence rate is approximately 3-20% especially in the first five years of the disease. Many factors such as high level of aPL, hyperhomocysteinemia, lupus disease activity, cerebral vasculitis, emboli from Libman-Sacks endocarditis, accelerated atherosclerosis cause stroke in SLE. Stroke related to vasculitis is a rare manifestation of NPSLE. Immune complex deposition in vascular endothelium, intrathecal immune complexes and other inflammatory mediators are involved in the pathogenesis of vasculopathy and vasculitis. Here, we present a 41-year-old Syrian woman with diagnosis of SLE and antiphospholipid antibody syndrome (APS). Her medical history showed several SLE attacks, ischemic cerebrovascular accidents (CVA) and seizure. Neurological examination revealed confusion, poor cooperation/orientation, left-sided hemiparesia. Cranial MRI, MRA and DSA findings were suggestive of vasculitis related to lupus. For the treatment, acetylsalicylic acid, clopidogrel, warfarin, cyclophosphamid 1g IV and uromitexan were applied. On the basis of this case, diagnostic and therapeutic approaches of NPSLE were discussed

Type
Chapter
Information
Rare Causes of Stroke
A Handbook
, pp. 66 - 71
Publisher: Cambridge University Press
Print publication year: 2022

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References

Daniel, JW, Dafna, DG. Clinical manifestations and diagnosis of systemic lupus erythematosus in adults. www.uptodate.com. Literature review current through: Mar 2020.Last updated: Dec.10,2019. (accessed January 2022).Google Scholar
Schur, PH. Neurologic manifestation of systemic lupus erythematosus in adults. www.uptodate.com. Literature review current through: Mar 2020.Last updated: Feb 21, 2019. (accessed January 2022).Google Scholar
Cooper, GS, Dooley, MA, Treadwell, EL, et al. Hormonal, environmental, and infectious risk factors for developing systemic lupus erythematosus. Arthritis Rheum. 1998;41(10): 17141724.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999;42: 599.3.0.CO;2-F>CrossRefGoogle Scholar
Hanly, JG, Kozora, E, Beyea, SD, Birnbaum, J. Review: Nervous system disease in systemic lupus erythematosus. Current status and future directions. Arthritis Rheumatol. 2019;71: 33.CrossRefGoogle ScholarPubMed
Saadatnia, M, Sayed-Bonakdar, Z, Mohammad-Sharifi, G, Sarrami, AH. The necessity of stroke prevention in patients with systemic lupus erythematosus. J Res Med Sci. 2012;17: 894895.Google ScholarPubMed
Holmqvist, M, Simard, JF, Asplund, K, Arkema, EV. Stroke in systemic lupus erythematosus: A meta-analysis of population-based cohort studies. RMD Open 2015;1: e000168.CrossRefGoogle ScholarPubMed
Duman, T, Demirci, S, Uluduz, D et al. Cerebral venous sinus thrombosis as a rare complication of systemic lupus erythematosus: subgroup analysis of the VENOST study. J Stroke Cerebrovasc Dis. 2019;28(12): 104372.CrossRefGoogle ScholarPubMed
Rowshani, AT, Remans, P, Rozemuller, A, Tak, PP. Cerebral vasculitis as a primary manifestation of systemic lupus erythematosus. Ann Rheum Dis. 2005;64: 784786.CrossRefGoogle ScholarPubMed
Pomper, MG, Miller, TJ, Stone, JH, et al. CNS vasculitis in autoimmune disease: MR imaging findings and correlation with angiography. Am J Neuroradiol. 1999;20: 7585.Google ScholarPubMed

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