Translate this page into:
The Reperfusion of Ischemic Vasculitis in a Patient with Neuropsychiatric Lupus: A Serial Single-Photon Emission Computed Tomography Study
Address for correspondence: Dr. Ana Carolina Trevisan, Nuclear Medicine Section of Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil. E-mail: acstrevisan@yahoo.com.br
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
Abstract
We report a 44-year-old female patient diagnosed with neuropsychiatric systemic lupus erythematosus and probable ischemia secondary to vasculitis in the speech motor region (Broca's area). After corticosteroid treatment, the patient recovered the speech, presented clinical improvement, and SISCOM showed reperfusion of the ischemic area (luxury perfusion).
Keywords
Aphasia
brain single-photon emission computed tomography
neuropsychiatric systemic lupus erythematosus
We report a female patient diagnosed with systemic lupus erythematosus (SLE). It should be presented with renal impairment, weight loss, and persistent proteinuria. After 2 years of the initial treatment, it should be patient had disease reactivation with neuropsychiatric involvement (neuropsychiatric systemic lupus erythematosus (NPSLE)), presenting hemiparesis on the right, acute confusional state, aphasia, and pancytopenia. Magnetic resonance imaging showed findings of cerebral infarctions in multiple territories but suggesting vasculitis in the left frontal inferior gyrus, Broca's area, responsible for the motor control of speech.[123] 99mTc-ethyl cysteinate dimer Single Photon Emission Computed Tomography (SPECT) showed marked perfusion deficit in the Broca's area during the acute phase. After treatment with corticosteroids, the patient recovered the speech, with clinical improvement, and the SPECT showed increased perfusion increase on Broca's area (luxury perfusion), associated to the right cerebellar diaschisis, which was evidence by SISCOM. NPSLE occurs as an autoimmune inflammatory alteration in the central and peripheral nervous system, with some impacts to the patient, mainly psychoses and cognitive dysfunction.[23] In the present patient, there was a probable ischemia secondary to vasculitis[4] in the speech motor area resulting in aphasia, and that was reversible after reperfusion of the ischemic cerebral parenchyma [Figure 1].
The patient's brain MRI showing multiple inflammatory lesions: (a, b and d) T1-weighted images with gadolinium showing a breakdown of blood–brain barrier and (c) T2-Fluid-attenuated inversion recovery sequence showing increased signal in both anterior frontal lobes and splenium of corpus callosum [Figure 2].
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- Evaluation of magnetic resonance imaging abnormalities in juvenile onset neuropsychiatric systemic lupus erythematosus. Clin Rheumatol. 2016;35:2449-56.
- [Google Scholar]
- Wernicke's encephalopathy mimicking neuropsychiatric symptoms in patients with systemic lupus erythematosus: A report of three cases and literature review. Lupus. 2017;26:195-9.
- [Google Scholar]
- Neuropsychiatric systemic lupus erythematosus: Tools for the diagnosis. Autoimmun Rev. 2014;13:831-9.
- [Google Scholar]
- Role of brain perfusion SPECT with 99mTc HMPAO in the assessment of response to drug therapy in patients with autoimmune vasculitis: A prospective study. N Am J Med Sci. 2015;7:135-42.
- [Google Scholar]