Friday, 29 November 2013

Cerebritis, Lupus, and Lupus Cerebritis - Diagnosis

Cerebritis is defined as an inflammation of the cerebrum, a structure associated with memory, speech, etc., as a result of the formation of an abscess within the brain itself, found commonly in patients with lupus.

Systemic lupus erythematosus (SLE) or Lupus is a chronic, autoimmune disease as as a result of the development of autoantibodies that attack the systems and organs in the body.researchers at the indicated that saturated fatty acid palmitate, but not unsaturated oleate, induces the activation of the NLRP3-ASC inflammasome, causing caspase-1, IL-1β and IL-18 production.

Lupus cerebritis is a disorder of nervous system problems (an autoimmune inflammatory disorder) caused by lupus as as a result of the development of autoantibodies that attack the systems and organs in the body. It causes migraine headache, if the duration of the central nervous system involvement last for a few minutes, or causes dementia that can lead to neurological deficits as a transient attacks or permanently.
There is no specific standard for the diagnosis, bur some researchers suggested
the following
1. Serologic tests
Is the test to measure the levels of specific antibodies in a patient's blood, the test is essential as the antinuclear antibody (ANA) titer is positive in virtually all patients with this disorder, but some researchers showed that serologic tests are helpful in establishing the diagnosis of SLE and predicting disease flares. However, there are few data on the relationship between the onset of new organ involvement and lupus serologies, especially in children.(11)

2. Electroencephalography (EEG) 
Electroencephalography (EEG) is to record the measurement of voltage fluctuations resulting from ionic current flows within the neurons of the brain. In a report of a 13-year-old girl with a known diagnosis of systemic lupus erythematosus presented with seizures and psychosis. An electroencephalogram (EEG) revealed continuous, non-evolving periodic lateralized epileptiform discharges (PLEDs) in the left temporal region, which did not resolve with benzodiazepine. A magnetic resonance imaging (MRI) brain scan demonstrated a focal hyperintensity in the left medial temporal and left occipital lobes, left thalamus and bilateral cerebellar white matter, with evidence of vasculitis in the magnetic resonance angiography. Intravenous immunoglobulin was given because of failed steroid therapy, which resulted in a full resolution of clinical, EEG and MRI abnormalities. Lupus cerebritis should be considered as a possible aetiology in (Focal (Nonepileptic) Abnormalities on EEG) PLEDs, and immunoglobulin can be effective in neuropsychiatric lupus.(14)

3. Computed tomography (CT scans)
In the study of thirty-four patients from the Jackson Memorial Hospital and Miami Veterans Administration Medical Center complex with 4 or more ARA criteria for SLE had CT of the brain. Of these patients with SLE, 14 had clinical features of cerebritis and 20 without cerebritis on longterm steroid therapy served as controls. Clinical examinations were performed by 1 of our group (NG). The CT of the brain was independently read by 2 neuroradiologists (SO and RQ), whose only knowledge of the patients was their age, sex and the diagnosis of SLE, showed that some abnormality of the brain by CT was present in 11/14 patients during their 1st attack of SLE cerebritis. At the initial presentation with SLE cerebritis, 9 of 14 patients had marked cortical atrophy by CT and 2 had minimal cortical atrophy. At that time, a normal CT was found on 3 patients with SLE cerebritis. Two of these patients were on 30 and 40 mg prednisone at the time of the normal CT. The 3rd had been on corticosteroids previously but not in 4 months prior to the normal CT. Corticosteroids were administered in all 3 patients and after remission and reexacerbation of SLE cerebritis, repeat CT demonstrated development of marked cortical atrophy in 2 of these patients and minimal cortical atrophy in the other. The role of corticosteroids in their cortical atrophy is unclear.(12)

4. A magnetic resonance imaging (MRI)
Most systemic lupus erythematosus patients having central nervous system involvement tend to have abnormal MRI scans, as cerebral edema that can occur due to cerebritis can be effectively identified by MRI scan(13) 

5. Etc. 

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