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October2011 Vol.48 Issue:        4        Table of Contents
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Neuropsychiatric Systemic Lupus Erythematosus: Magnetic Resonance Spectroscopic Study

Heba A. Selim1, Mahmoud A. Zaitoun1, Karam Selim1,

Eman A. Al-shahawy2, Enass M. Khatab3

Departments of Neurology1, Rheumatology & Rehabilitation2, Radiology3; Zagazig University; Egypt


Background: Although clinical assessment is still the cornerstone in the diagnosis of neuropsychiatric SLE (NPSLE), the diagnosis is often difficult. Proton magnetic spectroscopy (1H-MRS) has the ability to detect neurochemical brain abnormalities even in normal MRI areas in these patients. Objective: To evaluate the spectral brain changes using 1H-MR spectroscopy in NPSLE patients, and correlate their NP clinical data with  MRI and 1H-MRS abnormalities. Methods: 23 NPSLE patients and 8 healthy controls were included in this study. Neuropsychological tests were applied to all patients and controls for detection of impairment in any cognitive domains. Patients were classified into two groups; the first included NPSLE patients with normal MRI, while the other group with abnormal MRI. Single voxel proton MRS using point resolved spectroscopy sequence were evaluated in the parieto-occipital white matter in all patients and volunteers and in areas of MRI abnormal lesions. The relative ratios of NAA to Cr and Cho to Cr were measured. Results: Patients age ranged from 18-36, with mean±SD was 26.45±5.65 years, the most common NP features were headache and cognitive impairment with 39.1% for each of them, 9 patients (39.1%) had abnormal MRI imaging, while, spectral changes present in 20 patients (86.9%). MRS showed a significantly decreased NAA/Cr ratio and increased Cho/Cr ratio. In patients with abnormal MRI, the NAA/Cr ratio was significantly lower than those with normal MRI and control groups while the Cho/Cr ratio was significantly higher. Conclusion: In patients with NPSLE, 1H-MR spectroscopic findings seem to reflect the cerebral metabolic disturbances as functional abnormalities, related to the NP symptoms and it is a complementary tool to MRI as anatomical abnormalities in diagnosing the CNS involvement. [Egypt J Neurol Psychiat Neurosurg.  2011; 48(4): 359-366]

Key Words: neuropsychiatric manifestations, systemic lupus erythematosus, MRI, 1H-MRS.

Correspondence to: Heba Selim, Department of Neurology, Zagazig University, Egypt.

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