Central Nervous System Systemic Lupus Erythematosus: Pathophysiologic, Clinical, and Imaging Features

Area of Science:

• Neuroimmunology
• Systemic Autoimmune Diseases
• Central Nervous System Disorders

Background:

• Systemic lupus erythematosus (SLE) is a growing autoimmune disease with high mortality.
• Neuropsychiatric SLE (NPSLE) involves diverse neurological and psychiatric symptoms.
• NPSLE pathophysiology is complex, involving immune effectors and neuroimmune interfaces.

Purpose of the Study:

• To elucidate the mechanisms, imaging findings, and complications of NPSLE.
• To aid radiologists and clinicians in diagnosing and treating NPSLE.
• To classify NPSLE pathophysiology based on immunologic, pathologic, and imaging features.

Main Methods:

• Review of immunologic, pathologic, and imaging features of NPSLE.
• Classification of NPSLE pathophysiology into categories like vasculitis, APS, demyelination, and encephalitis.
• Analysis of neuroimmune interfaces including the blood-brain barrier and glymphatic system.

Main Results:

• NPSLE pathophysiology can be classified as vasculitis/vasculopathy, antiphospholipid syndrome (APS), demyelinating syndrome, or autoimmune antibody-mediated encephalitis.
• Distinct imaging characteristics exist for each pathophysiology, though overlap may occur.
• Complications arise from SLE and its treatments, impacting immunocompromised patients.

Conclusions:

• Familiarity with NPSLE mechanisms, imaging, and complications is crucial for diagnosis and treatment.
• Multiple immune effectors and breached neuroimmune interfaces contribute to NPSLE.
• Radiologists and clinicians require updated knowledge to manage NPSLE effectively.