Reversible focal neurological deficits in systemic lupus erythematosus: report of 2 cases and review of the literature.
We report two cases presenting focal neurological deficits with high intensity lesions in fluid attenuated inversion recovery (FLAIR) images on brain magnetic resonance imaging (MRI), which almost completely improved by corticosteroid therapy. Marked elevation of cerebrospinal fluid IL-6 was also noted when these patients showed neurological deficits. As far as we explored, there have been thirteen published case reports of systemic lupus erythematosus patients with reversible focal neurological deficits. The neurological symptoms varied from case to case, but could be attributed to the lesions on MRI scans. The completely reversible feature of neurological manifestations as well as MRI findings on corticosteroid therapy is distinct from any other disorder, including cerebrovascular disease and demyelinating syndrome, in the 1999 American College of Rheumatology nomenclature. Therefore, we propose that reversible focal neurological deficits should be added to the 1999 nomenclature and classification and case definitions.
Kimura
Miho
M
Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa 228-8555, Japan.
Aramaki
Kaori
K
Wada
Tatsuhiko
T
Nishi
Kazuo
K
Matsushita
Reiko
R
Iizuka
Nobuko
N
Hashimoto
Atsushi
A
Tanaka
Sumiaki
S
Ishikawa
Akira
A
Endo
Hirahito
H
Hirohata
Shunsei
S
D000328:Adult; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology* / Q000473:pathology