Stroke in systemic lupus erythematosus: epidemiology, mechanism, and long-term outcome

Estimados académicos y especialistas,
 
Les compartimos el artículo que publica la Dra. Paola Guraieb-Chahín, Dr. Carlos Cantú-Brito, Dr. Fernando. Flores-Silva, Dr. Erwin Chiquete, Dra. Alejandra González-Duarte, Sergio Iván Valdés-Ferrer publicado en conjunto con los siguientes doctores: A. Soto-Mota, L. Guerrero-Torres, H. Fragoso-Loyo. Les compartimos el abstract del articulo, así como la liga donde podrá ser consultado en su totalidad.
 
 

Stroke in systemic lupus erythematosus: epidemiology, mechanism, and long-term outcome.

Dra. Paola Guraieb-Chahín 1, Dr. Carlos Cantú-Brito 1, A. Soto-Mota 1, L. Guerrero-Torres 1, Dr. Fernando. Flores-Silva 1, Dr. Erwin Chiquete 1, H. Fragoso-Loyo 2, Dra. Alejandra González-Duarte 1 and Sergio Iván Valdés-Ferrer 1,3.

1 Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.
2 Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.
3 Center for Biomedical Science, Feinstein Institute for Medical Research, Manhasset, USA

Originally accepted / february 4, 2020 / https://doi.org/10.1177/0961203320908947

Abstract

To determine stroke prevalence, mechanisms, and long-term outcome in a cohort of Hispanic patients with systemic lupus erythematosus (SLE).

Methods

We analyzed demographical data, the timing between SLE diagnosis and stroke onset, stroke type, recurrence, and outcomes from an institutional database of 4451 patients with SLE followed from 1993 to 2018.

Results

We observed 139 strokes (3.1%), for an incidence rate of 1.25 per 1000 person-years: 81 (58.3%) acute ischemic stroke (AIS), 19 (13.7%) subarachnoid hemorrhage (SAH), 17 (12.2%) cerebral venous thrombosis, 13 (9.4%) intracerebral hemorrhage (ICH), and 9 (6.5%) transient ischemic attack. Median time from SLE diagnosis to acute stroke was 60 months (interquartile range 12–132 months). AIS had a bimodal presentation with 26% occurring within the first year and 30% >10 years after SLE diagnosis. In contrast, 75% of ICH cases occurred >3 years (and 34% >10 years) after SLE diagnosis. The most important cause of AIS was secondary antiphospholipid syndrome (48%). Hypertension was associated with 69% of ICH cases, while aneurysmal rupture was observed in 78% of SAH cases. Excellent recovery at hospital discharge was observed in 65%. Stroke recurrence was observed in 7%. The long-term all-cause fatality rate was 8%. Conclusions: The prevalence of stroke in this cohort was 3.1%. Ischemic strokes had a bimodal presentation, occurring either early after SLE diagnosis or after a several-year delay. Half of the hemorrhagic strokes occurred >10 years after the diagnosis of SLE. Clinical outcome was usually good with a relatively low recurrence rate.

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