plasmapheresis in cns lupus????

  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 (inflammation). 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!

[CCF Neurology M.D./DFG]

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Dear Ruth:
I have only seen plasmaphoresis used in Lupus-induced pripheral neuropathies, not in cases of CNS vasculitis of the intracranial vessels.
The potential causes of strokes in your case include vasculitis (which appears to be the diagnosis your physicians are leaning towards), antiphospholipid antibody syndrome, TTP, and cardiac valvular disease. If some of these possibilities have not been looked into,they are important to rule out.
Your current treatment sounds appropriate, although prednisone has been combined with calcium channel blockers to treat vasculitis with some success (Calabrese et al , Jul 1997).
I hope this has been helpful--good luck.