PMID- 14582367
OWN - NLM
STAT- MEDLINE
DCOM- 20031118
LR  - 20151119
IS  - 0009-918X (Print)
IS  - 0009-918X (Linking)
VI  - 43
IP  - 7
DP  - 2003 Jul
TI  - [A central nervous system lupus showing peculiar findings on cranial magnetic 
      resonance imaging (MRI)].
PG  - 409-16
AB  - We report a case of central nervous system (CNS) lupus showing peculiar findings 
      on cranial magnetic resonance imaging (MRI) with remarkable improvement after 
      corticosteriod therapy. The patient was a 28-year-old woman, admitted to our 
      hospital with severe fever, general malaise, and facial edema on June 4, 2001. 
      After admission, she was diagnosed with systemic lupus erythematosus (SLE). On 
      June 6, she showed diplopia at a distance, and on June 10, she suddenly became 
      unconscious and developed general convulsions. Cranial MRI showed asymmetrical, 
      multifocal, high signal intensity lesions on T2-weighted image (T2-WI) and low 
      signal intensity on T1-weighted image (T1-WI). These lesions were primarily 
      present in the subcortical white matter, with some detected in the overlying 
      cerebral cortex. Gadolinium (Gd)-DTPA enhanced T1-WI showed marked leptomeningeal 
      enhancement overlying the lesions on T1-WI and T2-WI. Apparent diffusion 
      coefficient image (ADCI) showed high signal intensity in the surrounding areas of 
      the T1-WI and T2-WI lesions, and low signal intensity in the central areas of the 
      lesions. Diffusion weighted image (DWI) showed high signal intensity in the 
      central areas of the low signal intensity on ADCI. Cerebrospinal fluid (CSF) 
      examination revealed albuminocytologic dissociation (cell counts of 2/microliter 
      and protein level of 108 mg/dl). CSF IgG index was elevated to 1.152 (normal < 
      0.7) and interleukin-6 (IL-6) activity to 27.2 pg/ml (normal < 4.0). On June 10, 
      Intravenous administration of high-dose methylprednisolone (1,000 mg/day for 3 
      days) was started to treat CNS lesions of SLE. Her CNS manifestations, CSF 
      findings, and the lesions on the cranial MRI improved remarkably. This is the 
      first case report describing the lesions on both ADCI and DWI in a case of CNS 
      lupus. The findings of ADCI and DWI suggest that the lesions of high signal 
      intensity on ADCI indicate interstitial edema caused by inflammatory 
      microangiopathy, and the lesions of high signal intensity on DWI and low signal 
      intensity on ADCI indicate cytotoxic edema caused by ischemic change resembling 
      microinfarction. We speculate that in addition to usual T1-WI and T2-WI, 
      performing ADCI and DWI is useful for understanding the pathogenesis of CNS lupus 
      lesions, and may play a significant role in the prognosis.
FAU - Takahashi, Teruyuki
AU  - Takahashi T
AD  - Department of Neurology, Nihon University Nerima-Hikarigaoka Hospital.
FAU - Kokubun, Yuji
AU  - Kokubun Y
FAU - Okuhata, Yoshitaka
AU  - Okuhata Y
FAU - Sawada, Shigemasa
AU  - Sawada S
FAU - Mizutani, Tomohiko
AU  - Mizutani T
LA  - jpn
PT  - Case Reports
PT  - English Abstract
PT  - Journal Article
PT  - Review
PL  - Japan
TA  - Rinsho Shinkeigaku
JT  - Rinsho shinkeigaku = Clinical neurology
JID - 0417466
RN  - 0 (Contrast Media)
RN  - K2I13DR72L (Gadolinium DTPA)
SB  - IM
MH  - Adult
MH  - Brain/*pathology
MH  - Contrast Media/administration & dosage
MH  - Diffusion Magnetic Resonance Imaging
MH  - Female
MH  - Gadolinium DTPA
MH  - Humans
MH  - Lupus Erythematosus, Systemic/*complications
MH  - Lupus Vasculitis, Central Nervous System/etiology/*pathology
MH  - *Magnetic Resonance Imaging
RF  - 18
EDAT- 2003/10/30 05:00
MHDA- 2003/12/03 05:00
CRDT- 2003/10/30 05:00
PHST- 2003/10/30 05:00 [pubmed]
PHST- 2003/12/03 05:00 [medline]
PHST- 2003/10/30 05:00 [entrez]
PST - ppublish
SO  - Rinsho Shinkeigaku. 2003 Jul;43(7):409-16.