Transcript magnetic resonance imaging in young patients with neuro

Magnetic Resonance Imaging In Young Patients With
Neuro - Psychiatric SLE : A Case Series
Dr. Vivek Gupta
Department of Radiodiagnosis
Postgraduate Institute of Medical Education and Research
Chandigarh INDIA
Introduction
• Neurological involvement is a frequent
occurrence in SLE.
• Associated with increase in morbidity and
mortality.
• About 50% of SLE patients have
neuropsychiatric phenomena at some time
during their illness.
Introduction
• NPSLE extremely difficult to diagnose wide variety of neuropsychiatric symptoms
of the disease
• Neuro-imaging has become important in
the evaluation of SLE patients with
neurologic symptoms.
AIMS & OBJECTIVES:
To describe the MR imaging pattern in children
and young adults with neuro psychiatric
involvement in systemic lupus erythematosus
(NPSLE).
Materials and methods
• Design:
– Retrospective case analysis.
• Methodology:
– Patients of systemic lupus erythematosus who
presented with neuro-psychiatric symptoms.
– Detailed history & clinical examination done in
all patients.
– All patients fulfilled the criteria of 1999
consensus document of ACR that defines the
neurologic and psychiatric manifestations of
SLE.
Materials and methods
• MRI brain performed on 1.5 Tesla system.
• Axial Tl-weighted images (TR: 570 ms; TE: 14 ms;
four excitations),
• Axial proton density and T2-weighted images
(TR 2735/2500 ms; TE 102 ms; two excitations).
• Coronal FLAIR sequences (TR: 8000ms TE :110ms)
• Diffusion imaging (TR 5700 ms TE139ms)
• MR scans were read by two neuroradiologists
who were blinded for the clinical information.
RESULTS
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Total patients = 14.
Mean age = 15.21 years (Range: 7-25 years).
Male: female = 5:9.
Mean duration of onset of illness: 2.4 yrs.
RESULTS
Clinical features
No. of patients
• Seizures
4 (28.5%)
• Chorea
2 (14.2%)
• Altered sensorium
5 (35.7%)
• Visual loss
2 (14.2%)
• Hemiparesis
2 (14.2%)
• Mononeuritis multiplex
1 (7.14%)
• Cranial neuropathy
1 (7.14%)
RESULTS
MRI findings
• White matter hyperintensities
• Non hemorrhagic Infarcts
• Hemorrhagic infarcts
• Myelitis
• Subarachnoid hemorrhage
• B/L subdural effusion
• PRES
• Cerebral atrophy
No. of patients
11
5
1
1
1
1
1
1
RESULTS
Location
No. of patient
• Cerebral hemispheres
10
• Spinal cord
1
• Cerebellum
1
• Combination
2
RESULTS
Typical imaging findings
RESULTS
White matter hyperintensities
White matter hyperintensities
Micro Infarcts
Infarction with hemorrrhage
Infarction with hemorrrhage
Hemorrrhagic infarcts
RESULTS
Atypical imaging findings
ISOLATED BRAIN STEM INVOLVMENT
ISOLATED BRAIN STEM INVOLVMENT
ISOLATED BRAIN STEM INVOLVMENT
ISOLATED BRAIN STEM INVOLVMENT
PRES
SUB ARACHNOID HEMORRHAGE
SUB ARACHNOID HEMORRHAGE
Discussion
• Incidence : 14% to 75 %
• Manifestations can range from mild to severe
• NPSLE events occur at the disease onset or
within 1-2 years after SLE diagnosis
Primary NPSLE
directly attributed to active disease
< 40 %
Secondary NPSLE
cause unrelated to SLE
ACR 19 NP Syndromes in SLE ( 1999)
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Acute confusional state
Cognitive dysfunction
Psychosis
Mood disorder
Anxiety disorder
Headache
Cerebrovascular disease
Myelopathy
Movement disorder
Demyelinating syndrome
Seizure disorders
Aseptic meningitis
Cranial neuropathy
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Polyneuropathy
Plexopathy
Mononeuropathy,single/ multiplex
Demyelinating polyradiculopathy
Autonomic disorder
Myasthenia gravis
Discussion
• Vasculopathy
• Infarction
• Haemorrhage
• White mater damage
• Infection
Summary
• Findings in young and children similar to
adults.
• Supratentorial involvement more common.
• Average time of onset of NPSLE 2 yrs.
• Atypical findings must be kept in mind to
avoid misinterpretation.
THANK YOU