Brain magnetic resonance imaging, cerebrospinal fluid, and autoantibody profile in 118 patients with neuropsychiatric lupus.

The objective of this study is to analyze clinical manifestations, features of imaging, and laboratory assessment of patients with neuropsychiatric SLE (NPSLE) for better diagnosis and outcome prediction. One hundred eighteen NPSLE patients admitted to the Anhui Provincial Hospital in Hefei, China, between January 2006 and December 2016 were enrolled and analyzed retrospectively. All patients fulfilled the American College of Rheumatology revised classification criteria for SLE. Patients with NPSLE fulfilled the American College of Rheumatology (ACR) nomenclature and case definitions. All NPSLE patients underwent neurological investigations including MRI of nervous system, electroencephalograms, or CSF examination as part of the diagnostic evaluation of nervous system involvement. All statistical analyses were performed. According to different types of data, different statistical methods were used to determine factors associated with abnormal MRI among NPSLE patients. Statistical significance was defined as P value < 0.05(two-tailed). Twelve different neurological manifestations of NPSLE patients were shown, in which headache was most common symptom (25.95%, 34/131), followed by seizures (25.19%, 33/131), cerebrovascular disease (18.32%, 24/131), psychosis (8.40%, 11/131), and others including mood disorder, cognitive dysfunction, plexopathy, cranial neuropathy, movement disorder, myelopathy, acute confusional state, and anxiety disorder. Thirteen patients have two neurological symptoms at the same time. Cerebrospinal fluid was assessed in 76 NPSLE patients, in which 29 patients had higher pressure of cerebrospinal fluid and 66 patients had abnormal immunoglobulin in cerebrospinal fluid, predominantly with an increase of IgG (84.21%, 64/76), followed by an increase of IgA (69.74%, 53/76), and IgM accounted for 47.74% (34/76). The MRI taken by 66.10% (78/118) patients have shown abnormal lesions and/or ischemic changes in the bilateral cerebral hemisphere, thalamus, pons, brainstem, and cerebellum. The abnormal changes in MRI were correlated with antiphospholipid antibody (APL) and C3 (P = 0.026 and 0.040, respectively). The most common clinical manifestation of NPSLE is headache, followed by seizures and cerebrovascular accident. The test of cerebrospinal fluid and MRI plays an important role in the assessment of NPSLE. The abnormal intracranial lesions were correlated with the level of anti-cardiolipin antibodies (ACL) and C3.