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Ann Rheum Dis. 1989 December; 48(12): 1014–1022.
PMCID: PMC1003941

Magnetic resonance and computed tomographic imaging in the evaluation of acute neuropsychiatric disease in systemic lupus erythematosus.


Magnetic resonance (MR) imaging and computed tomography (CT) are useful for the evaluation of central nervous system (CNS) lupus. This report describes the use of cranial MR and CT in 21 patients with systemic lupus erythematosus (SLE) with acute neuropsychiatric symptoms manifested by headache, seizures, focal neurological deficits, psychosis, or organic brain syndrome. Computed tomography was found to be insensitive and detected only diffuse atrophy (two cases), cerebral infarct (one case), and intracerebral haemorrhage (one case) in the 21 patients. Cranial MR images obtained with a General Electric 1.5 tesla Signa unit detected labile and fixed areas of increased proton intensity interpreted as focal oedema (eight cases), infarct (10 cases), haemorrhage (one), atrophy (seven), and acute sinusitis (two). Focal oedema was characterised by labile, high intensity lesions in the gray or white matter of the cerebellum, cerebrum, or brain stem, which completely resolved after aggressive corticosteroid treatment. Most high intensity reversible or fixed lesions evident on MR were not apparent on cranial CT images. In several patients sequential MR images were valuable in monitoring the efforts of treatment. Although histological confirmation of the high intensity brain lesions apparent on MR is desirable, prior necropsy studies suggest that pathological confirmation may be difficult owing to the paucity of recognisable brain lesions in patients with CNS lupus. It is concluded that for the evaluation of acute neuropsychiatric SLE MR is useful and provides more information than cranial CT.

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  • Grigor R, Edmonds J, Lewkonia R, Bresnihan B, Hughes GR. Systemic lupus erythematosus. A prospective analysis. Ann Rheum Dis. 1978 Apr;37(2):121–128. [PMC free article] [PubMed]
  • Feinglass EJ, Arnett FC, Dorsch CA, Zizic TM, Stevens MB. Neuropsychiatric manifestations of systemic lupus erythematosus: diagnosis, clinical spectrum, and relationship to other features of the disease. Medicine (Baltimore) 1976 Jul;55(4):323–339. [PubMed]
  • Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, Schaller JG, Talal N, Winchester RJ. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982 Nov;25(11):1271–1277. [PubMed]
  • Johnson RT, Richardson EP. The neurological manifestations of systemic lupus erythematosus. Medicine (Baltimore) 1968 Jul;47(4):337–369. [PubMed]
  • Pinching AJ, Travers RL, Hughes GR, Jones T, Moss S. Oxygen-15 brain scanning for detection of cerebral involvement in systemic lupus erythematosus. Lancet. 1978 Apr 29;1(8070):898–900. [PubMed]
  • Kushner MJ, Chawluk J, Fazekas F, Mandell B, Burke A, Jaggi J, Rosen M, Reivich M. Cerebral blood flow in systemic lupus erythematosus with or without cerebral complications. Neurology. 1987 Oct;37(10):1596–1598. [PubMed]
  • Wilson HA, Winfield JB, Lahita RG, Koffler D. Association of IgG anti-brain antibodies with central nervous system dysfunction in systemic lupus erythematosus. Arthritis Rheum. 1979 May;22(5):458–462. [PubMed]
  • Robbins ML, Kornguth SE, Bell CL, Kalinke T, England D, Turski P, Graziano FM. Antineurofilament antibody evaluation in neuropsychiatric systemic lupus erythematosus. Combination with anticardiolipin antibody assay and magnetic resonance imaging. Arthritis Rheum. 1988 May;31(5):623–631. [PubMed]
  • Bluestein HG. Neuropsychiatric manifestations of systemic lupus erythematosus. N Engl J Med. 1987 Jul 30;317(5):309–311. [PubMed]
  • Austin HA, 3rd, Klippel JH, Balow JE, le Riche NG, Steinberg AD, Plotz PH, Decker JL. Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs. N Engl J Med. 1986 Mar 6;314(10):614–619. [PubMed]
  • Vermess M, Bernstein RM, Bydder GM, Steiner RE, Young IR, Hughes GR. Nuclear magnetic resonance (NMR) imaging of the brain in systemic lupus erythematosus. J Comput Assist Tomogr. 1983 Jun;7(3):461–467. [PubMed]
  • Meyer MW, Wild JH. Letter: Unilateral internuclear ophthalmoplegia in systemic lupus erythematosus. Arch Neurol. 1975 Jul;32(7):486–486. [PubMed]
  • Lewis DC. Systemic lupus and polyneuropathy. Arch Intern Med. 1965 Oct;116(4):518–522. [PubMed]
  • Casey EB, Symon L. Systemic lupus erythematosus presenting as subarachnoid haemorrhage and space occupying lesion. Br J Dermatol. 1971 Feb;84(2):157–160. [PubMed]
  • Kelley RE, Stokes N, Reyes P, Harik SI. Cerebral transmural angiitis and ruptured aneurysm: a complication of systemic lupus erythematosus. Arch Neurol. 1980 Aug;37(8):526–527. [PubMed]
  • Lusins JO, Szilagyi PA. Clinical features of chorea associated with systemic lupus erythematosus. Am J Med. 1975 Jun;58(6):857–861. [PubMed]
  • Bennahum DA, Messner RP. Recent observations on central nervous system lupus erythematosus. Semin Arthritis Rheum. 1975 Feb;4(3):253–266. [PubMed]
  • April RS, Vansonnenberg E. A case of neuromyelitis optica (Devic's syndrome) in systemic lupus erythematosus. Clinicopathologic report and review of the literature. Neurology. 1976 Nov;26(11):1066–1070. [PubMed]
  • Kinney EL, Berdoff RL, Rao NS, Fox LM. Devic's syndrome and systemic lupus erythematosus: a case report with necropsy. Arch Neurol. 1979 Oct;36(10):643–644. [PubMed]
  • Carette S, Urowitz MB, Grosman H, St Louis EL. Cranial computerized tomography in systemic lupus erythematosus. J Rheumatol. 1982 Nov-Dec;9(6):855–859. [PubMed]
  • Bentson J, Reza M, Winter J, Wilson G. Steroids and apparent cerebral atrophy on computed tomography scans. J Comput Assist Tomogr. 1978 Jan;2(1):16–23. [PubMed]
  • Tan RF, Gladman DD, Urowitz MB, Milne N. Brain scan diagnosis of central nervous system involvement in systemic lupus erythematosus. Ann Rheum Dis. 1978 Aug;37(4):357–362. [PMC free article] [PubMed]
  • Hiraiwa M, Nonaka C, Abe T, Iio M. Positron emission tomography in systemic lupus erythematosus: relation of cerebral vasculitis to PET findings. AJNR Am J Neuroradiol. 1983 May-Jun;4(3):541–543. [PubMed]
  • Bilaniuk LT, Patel S, Zimmerman RA. Computed tomography of systemic lupus erythematosus. Radiology. 1977 Jul;124(1):119–121. [PubMed]

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