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Distinctive cerebral small vessel disease patterns are associated with ischemic stroke in systemic lupus

Guilherme D Silva1, Germana T Vieira2, Carolina de M Rimkus2

  • 1Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.

Lupus
|February 25, 2025
PubMed

Insights

Cerebral small vessel disease (CSVD) is more extensive in patients with systemic lupus erythematosus (SLE) who have had an ischemic stroke (IS). Cortical microbleeds were a distinctive feature in SLE patients with IS.

Area of Science:

  • Neurology
  • Immunology
  • Radiology

Background:

  • Systemic lupus erythematosus (SLE) elevates the risk of ischemic stroke (IS) and cerebral small vessel disease (CSVD) via complex cardiovascular and immune pathways.
  • Predictors for IS risk and unique CSVD characteristics in SLE patients remain poorly understood.

Purpose of the Study:

  • To determine if CSVD is more prevalent in SLE patients with IS compared to those without IS.
  • To identify specific neuroimaging markers of CSVD in SLE patients.

Main Methods:

  • An observational study of 106 SLE patients (53 IS+, 53 IS-) who underwent brain MRI.
  • Two neuroradiologists assessed CSVD using a summary score (microbleeds, lacunes, enlarged perivascular spaces, white matter hyperintensities).
  • Logistic regression analyzed the association between CSVD and IS, adjusting for covariates.

Main Results:

  • A higher summary CSVD score was independently associated with IS in SLE patients (OR 3.83, p=0.002).
  • This association persisted after adjusting for age, hypertension, antiphospholipid syndrome, and antimalarial use.
  • Distinctive CSVD patterns included cortical microbleeds (92%), basal ganglia lacunes (63%), and deep white matter hyperintensities (80%).

Conclusions:

  • CSVD is more common in SLE patients with IS than in those without, suggesting CSVD may be an IS risk biomarker.
  • The predominance of cortical microbleeds in SLE-associated IS differs from typical age-related or hypertension-related CSVD patterns.
  • Further prospective research is needed to validate CSVD as a predictive biomarker for IS in SLE.

Keywords:
Cerebral small vessel diseasesischemic strokeleukoaraiosismicrobleedssystemic lupus erythematosus

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