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Neuropsychiatric manifestations of systemic lupus erythematosus (SLE) are diverse and heterogeneous.1 We report a patient who experienced a flare of SLE with subacute transverse myelopathy. Magnetic resonance imaging (MRI) showed atrophy of the entire central nervous system (CNS). Apart from psychosis at SLE onset, there had not been any neuropsych...
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Context 1
... neuropathic bladder was present, but there was no optic neuritis or livedo reticularis. A CT scan showed atrophy of the brain and calcification of the basal ganglia (fig 1). MRI showed diffuse thinning of the entire spinal cord without abnormal signals in the intramedullary regions (fig 2). ...
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Background
Spinal cord lesions is one of the predominant characteristics in patients with neuromyelitis optica spectrum disorders (NMOSD). Interestingly, mounting evidence indicates that spinal cord atrophy (SCA) is one of common clinical features in multiple sclerosis (MS) patients, and correlates closely with the neurological disability. However,...
Citations
1. Bei einem seit fast 9 Jahren an Lupus erythematodes visceralis leidenden 26jährigen Mann trat der Tod wenige Tage nach erstmaligem Auftreten zentralnervöser Krankheitssymptome ein. Die Autopsie ergab eine akute Meningomyeloencephalitis mit Schwerpunkt der Veränderungen im Rückenmark und im Tuber cinereum. Verschiedene feingewebliche Besonderheiten charakterisieren den Prozeß und trennen ihn von allen bisher bekannten Encephalomyelitiden ab.
2. Hierher gehören regressive Zellkernveränderungen der entzündlichen Elemente im Sinne der Pyknose und Karyorrhexis sowie eigenartige Cytoplasmaeinschlüsse, die als Ausdruck des L.e.-Phänomens aufgefaßt werden.
3. Hierher gehören ferner die Zeichen schwerer Permeabilitätsstörungen und deren Folgen, wie Verquellungen der Gefäßwände, Plasmaextravasate, Diapedesisblutungen, ödembedingte Nekrosen, und die gliös-mesenchymalen Reaktionen darauf.
4. Subtile Veränderungen, vor allem endarteriitische Prozesse der Meningealgefäße, weisen darauf hin, daß schon früher zentralnervöse Krankheitsschübe klinisch unbemerkt abgelaufen sind.
5. Obwohl das klinische Bild seit Jahren an der Diagnose keinen Zweifel ließ, fehlen am sonstigen Autopsiebefund jene Veränderungen, die als typisch für den L.e.v. gelten: Keine Endokarditis Libman-Sacks, keine deutlichen „Drahtschlingengefäße“ in den Nieren, keine Hämatoxylinkörper, hingegen Granulome in Leber und Lunge und eine diffuse, vorwiegend lymphocytäre Hyperplasie der Lymphknoten.
Neuropathological examination in a 48-year-women of SLE with chorea was performed. Histological examination of the putamen showed a widespread neuronal loss associated with reactive astrocyte proliferation and neuropil rarefaction at both sides. Disappearance of large neurons was more prominent than that of small ones. Although a few old and fresh microinfarcts were scattered in the same area, there was no significant pathological abnormality in small vessels. The caudate nuclei also showed a few irregular microinfarcts and spotty loss of neurons associated with reactive astrocytosis. These neuropathological changes might be related to the appearance of choreatic movement in patients with SLE.
Disease modifying antirheumatic drugs (DMARDs) have become the cornerstone of treatment for patients with rheumatoid arthritis. The use of these drugs during the perioperative period has caused debate amongst rheumatologists and surgeons. Concerns focus on their potential to increase the risk of infection by affecting the immune response. Rheumatoid patients are at increased risk of infection,1 and this is of concern after surgery.2 Orthopaedic surgery in rheumatoid patients is common,3 and while it may seem prudent to stop DMARD treatment before surgery, this may result in flare up of disease activity. The resultant loss of mobility would adversely affect outcome, particularly after orthopaedic procedures, where mobilisation is crucial for effective rehabilitation.2,4
Early reports suggested that methotrexate should be stopped before rheumatoid surgery, as it was claimed to increase infection rates. Studies have …
