When Your Head Hurts When Your Head Hurts and Your Memory and Your Memory Fails- Is It Your Fails- Is It Your Lupus? Lupus? Petros Efthimiou, MD, FACR, Petros Efthimiou, MD, FACR, Lincoln Medical and Mental Health Center Lincoln Medical and Mental Health Center Assistant Professor of Medicine, Assistant Professor of Medicine, Weill Cornell Medical College, Weill Cornell Medical College, New York, NY New York, NY
A Presentation by Petros Efthimiou, MD at Lincoln Hospital, Bronx, New York
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When Your Head Hurts and When Your Head Hurts and Your Memory Fails- Is It Your Memory Fails- Is It
Your Lupus?Your Lupus?
Petros Efthimiou, MD, FACR,Petros Efthimiou, MD, FACR,Lincoln Medical and Mental Health CenterLincoln Medical and Mental Health Center
Assistant Professor of Medicine,Assistant Professor of Medicine,Weill Cornell Medical College,Weill Cornell Medical College,
New York, NYNew York, NY
LUPUSLUPUS
CHRONICCHRONIC
AUTOIMMUNEAUTOIMMUNE
The body’s autoimmune system (“defense")
attacks ITSELF
Skin
Kidney
Lung
Heart
Joints
Blood
Nervous System
Progressive
Long Standing
MULTISYSTEMIC
Incidence: 7.6/100,000/year (pooled from a number of studies)
Prevalence: 14.5-50.8/100,000
Hochberg’s Prevalence: 372/100,000
US: close to 1 million people
SLE Lupus Foundation: probably 1.5 million
inci
den
ce
1950 2000
10
5
2
Epidemiology of SLEEpidemiology of SLE
T Cell
Abnormal Adhesion Molecule and Chemokine Expression
Tissue Specific PathologyAPC
B7
MHC
FcR
CR RES
AutoAb
DrugsUVInfectious Agents
Genetic Background
Estrogens
B CellIncreased Help
Decreased Cytotoxicity
Altered Cytokine Production
IL-6, IL-10 IL-2
DC
IFN
AutoAg
Apoptosis+ Immune
Complexes
How Does Lupus happen?
American College of Rheumatology American College of Rheumatology Criteria For LupusCriteria For Lupus
Sudden numbness or weakness especially on one side of the body with an associated tingling sensation Sudden confusion or trouble speaking or understanding
Sudden trouble seeing
Sudden trouble walking, dizziness, loss of balance or coordination
An organic basis for the headaches in SLE is suggested by the sudden developmentin someone previously free of headaches, associated with Neurologic changes or changes in personality.
Migraine and tension Headaches are the most common type of presentation.
Migraine:Throbbing or pounding pain Nausea and vomiting Scalp tenderness Sensitivity to light or sound Worsening of pain with movement Visual disturbancesDizziness or vertigo
Tension headachePressing/tightening (nonpulsating) quality, located on both sides of the head Mild or moderate intensity Not aggravated by routine physical activity No nausea or vomiting Possible sensitivity to light or sound but not both
May present as:Temporary numbness, tingling, and pricking sensations (paresthesia) Sensitivity to touch Muscle weakness Burning pain (especially at night) Muscle wasting Paralysis Organ or gland dysfunction. Difficulty digesting food, maintaining safe levels of blood pressure, sweat normally, or experience normal sexual function.
Predominantly fixed lesions in the periventricular and Subcortical White Matter
Focal Neurologic DiseaseFocal Neurologic Disease
More Sensitive than CT Scan and T1- Weighted MRI More Sensitive than CT Scan and T1- Weighted MRI for detecting Abnormalities in NP-SLEfor detecting Abnormalities in NP-SLE
T2- Weighted MRIT2- Weighted MRI::
Findings:
Diffuse Neurologic DiseaseDiffuse Neurologic Disease Transient Subcortical White Matter Lesions and patchyHyperintensities in the Gray Matter