Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Microembolic Signals Detected by Transcranial Doppler Ultrasound Corresponds to Persistence of Foramen Ovale in Neuropsychiatric Lupus with Brain MRI Abnormalities.

Padovan2,  Melissa, Bortoluzzi2,  Alessandra, Azzini1,  Cristiano, Vito1,  Alessandro De, Tola1,  Maria Rosaria, Trotta3,  Francesco, Govoni3,  Marcello

Neurology Unit, Department of Neurosciences, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna - Ferrara, Ferrara, FE, Italy
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna - Ferrara (Italy)

Background:

Magnetic resonance imaging (MRI) abnormalities, as small punctuate hyperintense lesions in subcortical and periventricular brain white matter areas (WMHL) are a frequent but not specific finding in systemic lupus erythematosus (SLE) patients with and without neuropsychiatric (NP) involvement. Their pathogenesis is not fully understood yet, being recurrent cerebral micro-embolism - detectable through transcranial Doppler ultrasound (TCD) - one of the hypothesized mechanism. In general population microembolic signals (MES) may be detected with a reported frequency of about 15 % often due to the persistence of foramen ovale.

Aim:

To assess the frequency of microembolic signals (MES) by using transcranial Doppler (TCD) ultrasound in SLE patients with and without brain MRI abnormalities.

Methods:

A TCD registration to detect MES from the middle cerebral artery was carried out accordingly to a local standardized protocol in 21 SLE patients (mean age of 42,2 years, range 32–55) with and without NP involvement lupus, after exclusion of aortic and/or carotid atheromatous disease. In all patients brain magnetic resonance imaging (MRI) and transesophageal echocardiography were performed. Patients were stratified in two groups, with and without MRI WMHL and compared. Antiphospholipids antibodies (APL) and lupus anticoagulant (LA) status were checked too.

Results:

MES were detected in a total of 11 patients (52,3%), 4 APL/LA+ and 7 APL/LA-, 9 out of 15 patients (60 %) with abnormal MRI and history of NP SLE had MES compared with 2 out of 6 patients (33.3 %) with normal MRI (1 NPSLE and 5 without NP involvement). No correlations between MES and APL or LA were found. The persistence of foramen ovale was confirmed in almost all case of MES detection. However with abnormal MRI only one case did not show persistence of foramen ovale.

Conclusion:

Compared with what has been reported in general population, MES is a frequent finding in SLE patients irrespective of their previous history of NP involvement and more prevalent in patients with MRI abnormalities compared with patients with normal MRI. These finding either suggest caution in the interpretation of MRI pictures and a careful evaluation of MES in patients with MRI abnormalities which should be included in the work-up of SLE patients prompting further investigations for micro-embolic sources (i.e. carotid plaques and/or right-left shunt due to the persistence of foramen ovale).

To cite this abstract, please use the following information:
Padovan, Melissa, Bortoluzzi, Alessandra, Azzini, Cristiano, Vito, Alessandro De, Tola, Maria Rosaria, Trotta, Francesco, et al; Microembolic Signals Detected by Transcranial Doppler Ultrasound Corresponds to Persistence of Foramen Ovale in Neuropsychiatric Lupus with Brain MRI Abnormalities. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1162
DOI: 10.1002/art.28928

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