Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Subject: Re: plasmapheresis in cns lupus????
Forum: The Neurology and Neurosurgery Forum
Topic Area: Lupus
Posted by CCF Neurologist M.D./DFG on August 24, 1998 at 22:58:57:
In Reply to: plasmapheresis in cns lupus???? posted by ruth on August 24, 1998 at 00:04:05:


I have cns lupus involvement- just did IV pulse therapy 3 weeks ago- helped a lot - but now I am losing vision again. I have "mini - infarcts" on mri -or some kind of vascular damage and MR angiogram indicates posterior cerebral artery circulation problems possibly from inflamation. I do not have any of the antiphosp or anti-cardiolipin antibodies that were tested for but am on aspirin in case there is a hyperviscosity problem. I am also on oral imuran and high dose oral pred. Since I am losing vision again
( right visual field loss and have had optic nueritis) we have been thinking aobut trying some different treatments to help until the imuran kicks in.
My question is-- how effective is plasmapharesis in CNS lupus problems like mine? We have also considered heparin therapy and coumadin since I had it in the past and it helped ( that was before my dx of lupus) but one of my docs is wary of doing it because of the risks of bleeding. I am just trying to get info on this to talk to my docs about. Thanks!
_____

Dear Cheree:

I have seen plasmaphoresis used in cases of SLE (i.e. Lupus) induced
peripheral neuropathies, but not in a case such as yours, which appears
to be intracranial vasculitis. Focal neurologic deficits (in your case
visual symptoms) from strokes in patients with lupus must also be tested
for antiphospholipid antibody syndrome (done in your case), cardiac valvular disease (an Echocardiogram test), TTP (Thrombotic Thrombocytopenic Purpura), and CNS Vasculitis. These are all likely causes of stroke in the setting of Lupus. If some of these possibilities have not been checked out, make a request to your primary physician.

The treatments you listed as current(imuran, prednisone) are all appropriate for your condition. The use of calcium channel blockers with
prednisone has also been successful in treating vasculitis (Calabrese et al, Arthritis and Rheumatism, July 1997).

I hope this has been helpful- good luck

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