The clinical significance of microembolic signals in patients with systemic lupus erythematosus.
BACKGROUND
Microembolic signals (MES) have been found in about 10% of patients with systemic lupus erythematosus (SLE), and have been associated with neuropsychiatric manifestations (NPSLE), including cerebrovascular damage.


OBJECTIVE
To determine the frequency of MES in patients with SLE, previous and further risk of neuropsychiatric manifestations.


METHODS
One hundred and nine consecutive patients with previous diagnosis of SLE and without acute neurological manifestations were evaluated clinically and by transcranial Doppler monitoring (1 hour) from November 2002 to March 2003. The baseline characteristics and outcomes were compared between patients with and without MES. Patients were followed during a mean time of 4.5 years, to detect the appearance of NPSLE, including stroke and transient ischemic attacks.


RESULTS
MES were detected in 16 patients (14.7%; range: 3-64/h); at baseline, previous neuropsychiatric manifestations were more frequent in patients with MES: 12/16 (75%) versus 46/92 (50%) (p=0.064), especially for cognitive dysfunction (p=0.036). Antiphospholipid syndrome and cardiovascular risk factors did not differ between groups at baseline and follow-up, neither the proportion of patients on antiplatelet agents. At follow-up, two patients from the MES positive group and six from the MES negative group developed a new neuropsychiatric manifestation (p=not significant).


CONCLUSIONS
This study supports an association of MES and a history of NPSLE, especially cognitive dysfunction. MES were not associated with an increased risk of cerebral ischemia and other neurological manifestations at follow-up.
Cantú-Brito
Carlos
C
Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México DF, México.
Baizabal-Carvallo
José Fidel
JF
Alonso-Juárez
Marlene
M
García-Ramos
Guillermo
G
D000328:Adult; D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D012307:Risk Factors; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult