Background/Purpose: Ischemic strokes in Systemic lupus erythematosus (SLE) patients contribute to increased morbidity and mortality.  Little is known however, about the patterns of ischemic brain injury in SLE and how this issue impacts the clinical outcome. Our objective is to investigate the neuropsychological, neurobehavioral and physical function in SLE patients with ischemic stroke, and correlate findings with the type of arterial ischemic injury.

Methods: Consecutive SLE patients presented with first-ever ischemic stroke drawn from the Maryland Lupus Cohort from 2000 to 2014 were observed.  Ischemic brain injury was categorized based on brain magnetic resonance imaging (MRI/ MRA) into infarctions of large territorial, lacuanar, localized cortical and borderzone. Angiographic findings were staged to assess severity of arterial stenotic lesion. Comparison was made to age- and gender -matched SLE patients with no stroke, and non SLE ischemic stroke subjects. Primary outcomes determined at 6 months post stroke included, cognitive dysfunction, mood disorders, emotion/ affective disorders and physical function.

Results: 56 SLE patients with stroke (mean age 35.7 years, 82 % women, 84 % African American, mean duration of SLE 5.5 years), 44 SLE patients with no stroke (mean age 32.9 years, 93 % women, 77 % African American, mean duration of SLE 6.5 years ) and 20 Non SLE stroke subjects (mean age  37.5 years, 80 % women, 90 % African American) were included. There was no significant statistical difference among the three groups regarding demographic and clinical features, phospholipid syndrome, disease activity, co-morbid conditions, treatment or stroke rehabilitation care.

Poor cognitive performance in SLE patients with stroke was frequently associated with subcortical damage with and without white matter intensity ( p value < 0.003), as compared to major cortical syndrome in non SLE stroke subjects (P value < 0.010), after adjusting for vascular risk factors.  Cognitive domains of memory, orientation, language, and attention were more defective in SLE patients with stroke when compared with SLE patients with no stroke or non SLE stroke subjects.

Post stroke depression and emotional incontinence were associated with cognitive impairment among SLE patients with stroke and non SLE stroke subjects, regardless of coping style, anti-depressant intake, severity of steno-occlusive disease, or phospholipid syndrome.  Post stroke depression was associated with cortical (OR: 1.5, 95 % CI: 1.0- 2.7), and subcortical lesions (OR: 12.0, 95 % CI: 1.8-78.2) among SLE patients, compared to right hemispheric lesion (OR: 1.2, 95 % CI: 1.0- 2.6) in non SLE stroke subjects.

Functional impairment was greater among SLE patients with focal brain injury (OR: 2.2, 95% CI: 1.1-25.6), and those with cognitive impairment (OR: 3.0, 95% CI: 1.7- 14.8), after adjusting for co-morbid condition and severity of stroke.

Conclusion: Ischemic brain injury in SLE is associated with cognitive impairment, depression, emotional incontinence and physical disability.  Better understanding of the mechanism of vascular brain injury in SLE will improve patient care and facilitate the development of therapeutic options and effective rehabilitative measures.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patterns-of-vascular-brain-injury-in-systemic-lupus-erythematosus-patients-with-ischemic-stroke-impact-on-neuropsychological-neurobehavioral-and-physical-function-outcome/