RESEARCH - MRI pegs cognitive dysfunction as noteworthy clinical feature in multisystem antiphospholipid syndrome

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1/3/2007

By: Shalmali Pal

MRI pegs cognitive dysfunction as noteworthy clinical feature in multisystem

APS

Cerebral microvasculopathy could be an underlying mechanism for cognitive

dysfunction, based on MR studies performed in patients with antiphospholipid

syndrome (APS), according to Greek investigators.

APS, broadly defined as the presence of arterial or venous thromboses

associated with antiphospholipid (aPL) antibodies, often occurs in

conjunction with systemic lupus erythematosus (SLE). This thrombosis can

occur at any vascular site and in any organ system, said Dr.

Tektonidou from the department of pathophysiology at the National University

of Athens School of Medicine and the Athens-based Euroclinic Hospital.

" Abnormal MRI findings in APS include single or multiple infarcts,

white-matter lesions (WMLs), cortical atrophy, and focal hemorrhage, " they

wrote. For this cross-sectional study, 60 patients with definitive APS and

60 healthy volunteers were enrolled (Archives of Internal Medicine, November

13, 2006, Vol. 166: 20, pp. 2278-2284).

The APS patients were divided into two groups: those with central nervous

system (CNS) involvement and those who had never had a neuropsychiatric

event. The gadolinium-enhanced MR protocol included sagittal and axial

spin-echo T1-weighted images, axial spin-density T2-weighted images, and

proton-density, fluid-attenuated inversion-recovery images on a 1.5-tesla

scanner. Co-author and radiologist Dr. Grigorios Kotoulas read the images.

" Infarcts were defined as focal lesions with increased signal intensity on

T2-weighted images and reduced signal intensity on T1-weighted images, " the

authors explained. " White-matter lesions on MRI were identified as

ill-defined hyperintensities on T2-weighted and proton-density,

fluid-attenuated inversion-recovery images without prominent hypointensity

on T1-weighted images. We classified WMLs according to their location (and)

to their size as punctuate. "

According to the results, a significant association was found between the

presence of WMLs on MRI and livedo reticularis, a dermatologic manifestation

of APS characterized by diminished blood flow in the arterioles and dilation

of venules and capillaries.

In addition, a significant association was found between cognitive deficits

and small periventricular, as well as subcortical, WMLs, particularly in

patients with no CNS involvement. Specifically, 88% of the patients with

WMLs and no CNS symptoms had cognitive deficits versus 21% without WMLs.

" The absence of any association between cognitive abnormalities and a

history of CNS involvement is of particular interest, " the authors wrote.

" The pathogenesis of WMLs remains unknown, but it is generally thought that

WMLs are related to vascular disease in the long penetrating arteries of the

brain. "

Finally, no association was found between cognitive deficits and brain

infarcts on MRI. The results help to broaden the range of neurological

manifestations found in APS, the authors stated.

By Shalmali Pal

AuntMinnie.com staff writer

January 3, 2007

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