Late ophthalmological manifestations in patients with subarachnoid hemorrhage and coiling of cerebral aneurysm.

Late ocular manifestations of aneurysmal subarachnoid hemorrhage (SAH) have not been previously investigated except for one study which demonstrated that one half of patients subjected to aneurysm clipping suffer from symptoms of visual pathway impairment. We assessed ophthalmological status of patients after 1-4.5 years from SAH and aneurysm embolization to identify predictors of damage to the visual pathways. Complete ophthalmological examination, static perimetry, and visual evoked potentials (VEPs) were performed in 74 patients (26 men, 48 women, aged 19-76 years), who constituted a consecutive sample of 129 patients treated with aneurysm embolization in the years 2008-2010. The following independent variables: sex, age, time from SAH to embolization, size and site of aneurysm, score in Glasgow Coma Scale, Glasgow Outcome Scale, Hunt-Hess and Fisher scales were subject to univariate and multivariate statistical analyses to study their influence on the ocular outcome. 40 patients (54%) demonstrated visual field defects appearing as multiple peripheral foci and constricted field, affecting both eyes. Among these subjects, 12 patients had severe defects in the visual field, 20 had deterioration in VEPs, and 9 had decreased visual acuity. Older age and high score in Hunt-Hess and Fisher scales were identified as predictors for visual field defects and disturbances in VEPs. More than half of the survivors of SAH and aneurysm embolization suffer from a permanent defect in visual function. Damage of visual pathway correlates with severity of SAH and older age of patients.

[Evaluation of the effectiveness of endovascular embolization for the treatment of ruptured cerebral aneurysms]. / Ocena skutecznosci embolizacji wewnatrznaczyniowej w leczeniu peknietych tetniaków mózgu.

Endovascular embolization of ruptured intracranial aneurysms is a relatively new and still developing technique, therefore its efficiency and risks should be assessed recurrently, including also results obtained in national centers. AIM: The aim of the study was to present a synthetic review of the literature, which, including the data published by the Polish centers, typify the global assessment of the effectiveness and early complication of endovascular embolization in patients with ruptured brain aneurysms. MATERIALS AND METHODS: Our review of the literature includes 24 papers listed in PubMed and Medline, including also two Polish case series. The following data were extracted from the publications and compiled into global characteristics of a case series: basic characteristic of the study group, neurological status on admission, feasibility of procedure, incidence of complications and their type, outcome at discharge and intraoperative morbidity and mortality. RESULTS: Effective embolization was feasible in 94.4% of patients. Total occlusion of the cerebral aneurysm (99-100%) during initial procedure was achieved in 60.7% of patients. Intraoperative complications occurred in 12.6% of individuals. The most frequent type of intraoperative complication was thromboembolism, which occurred in 6%. As much as 65.2% of patients scored 4 or 5 in GOS on discharge. CONCLUSIONS: Endovascular embolization is highly effective in the treatment of ruptured cerebral aneurysms, featured also by a low rate of intra-procedural complications. The majority of patients are discharged in good shape and neurological status, scoring 4-5 in GOS.

Early outcomes and perioperative complications of endovascular embolization in patients with aneurysmal SAH.

BACKGROUND: We still lack reliable data on the outcomes of endovascular coiling for ruptured cerebral aneurysms. As this is still an evolving technique, the outcomes of the procedures performed in the past and more recently cannot be directly compared. We present the early outcomes of endovascular coiling in a relatively large group of patients with ruptured intracranial aneurysms. METHOD: The study included 190 consecutive patients (a total of 216 aneurysms) subjected to endovascular coiling in 2006-2013 (127 women aged 56±13 years and 63 men aged 50± 15 years). Up to 87.5% of the aneurysms were located within anterior circulation. Most patients presented with "mild to moderate" subarachnoid hemorrhages (85% of Hunt &Hess scores 1-3, and 72% of Fisher scores 1-3). RESULTS: Embolization was feasible in 176 (92.6%) patients. In 14 cases, the embolization was not attainable due to unfavorable anatomy of the aneurysm, intraoperative vasospasm and/or aneurysm rupture, or prolapse of a coil. Early complications related to the procedure were recorded in 23 (13.1%) patients. The most common perioperative complication was aneurysm rupture. All fatal complications occurred in patients with aneurysms located at the anterior circle of Willis. At the time of discharge, 126 patients scored 4 or 5 on the Glasgow Outcome Scale. CONCLUSIONS: Endovascular embolization is an effective and relatively safe method for treatment of ruptured cerebral aneurysms. Complications related to the procedure are significantly less frequent in the case of vertebral-basilar complex aneurysms.

Early surgical removal of migrated coil/stent after failed embolization of intracranial aneurysm.

OBJECT: Distal coil or stent migration is a rare, but potentially morbid complication of intracranial aneurysm embolization. At present, there is no established standard of surgical evacuation of displaced material-in particular, there is no consensus on the optimum time for such intervention. The authors report their positive experiences with an ultra-early surgical evacuation of 2 migrated coils and a flow-diverter stent. METHODS: Uncontrolled coil or stent migration occurred in 3 (0.75%) of approximately 400 patients treated between 1999 and 2012 in the authors' institution. In all 3 cases, the materials moved from their intended position to the middle cerebral artery (MCA). Surgical evacuation was started immediately (within half an hour) after a futile attempt of removing them via intraarterial route, under the same anesthesia and with no active reversal of heparinization. RESULTS: No excessive bleeding was observed. Displaced coils were extracted through an incision of a branch of MCA-the anterior temporal artery, the stent was removed through a direct incision of MCA. Recombinant tissue plasminogen activator (rtPA) was injected to the stem of the internal carotid artery toward the end of the procedure, with no discernible adverse effects. Two patients were discharged with no deficit (Glasgow Outcome Scale [GOS] Score 5); the other patient was conscious with mild hemiparesis (GOS Score 4) at discharge. CONCLUSIONS: The experiences of these 3 cases suggest that immediate removal of a migrated stent/coil is feasible and may be effective. Indirect access to the MCA through its branch helps to shorten the time of temporary clipping of the artery to a minimum. Maintaining active heparinization and direct intraarterial injection of rtPA are helpful in promoting blood flow in the MCA.

Vertebroplasty of cervical vertebra.

BACKGROUND: The first vertebroplasty was performed by Harve Deramond in France in 1984 due to a hemangioma of cervical vertebral body. Procedure technique consisted of inserting a needle through the bony palate of the oral cavity. Bone cement injected under pressure not only fills the areas of bone loss. The heat released in the process of crystallization causes denaturation of pathological tissue proteins (metastasis) and disrupts blood supply (hemangiomas). The aim of this study was to evaluate the method of treatment from anterolateral access. MATERIAL/METHODS: In the years 2007-2012 the procedure was performed in 6 men and 9 women aged from 42 to 71 years (mean age: 56.3 years). In 10 cases the reason for vertebroplasty was the vertebral hemangioma, in another 4 - pathological vertebral fractures due to metastases, and in one case - multiple myeloma. Procedures were performed from anterolateral access, under local anesthesia, under x-ray guidance (fluoroscopy). Bone needle was inserted into the vertebral body, followed by injection of PMMA cement. RESULTS: In 100% cases pain relief was observed immediately after the procedure and beneficial therapeutic effect was obtained. No life-threatening complications and clinical symptoms were observed. Average length hospital stay amounted to 2.9 days. CONCLUSIONS: Cervical spine vertebroplasty from anterolateral access seems to be a safe, effective and beneficial method of treatment. It reduces the risk of infection in comparison to the transoral method.

[Embolization of carotid arteria branch in stanching of nasal bleeding]. / Embolizacja galezi tetnicy szyjnej zewnetrznej w tamowaniu krwawien z nosa.

BACKGROUND: Epistaxis is a common clinical problem, especially in otolaryngology. This disorder affects equally both genders. Most cases manifest as spontaneous nasal bleeding. It can also appear as a result of trauma, high blood pressure, Osler-Rendu-Weber disease. When the bleeding is massive it can be potentially life-threatening. A great majority of epistaxis can be treated conservatively, if not it sometimes requires endovascular treatment. It is specially reserved for extensive, dangerous epistaxis. Angiography with selective embolization has become an accepted method of treating epistaxis that is not controlled with conservative methods. MATERIAL AND METHODS: Authors analyzed the efficacy of selective embolization treatment of epistaxis. 61 patients treated in the Department of Otolaryngology in Bialystok in years 1999-2011 were examined. There were 39 men and 22 women aged 24-48 years. Patients were referred for endovascular treatment when primary management was ineffective. Arteries suspected of bleeding were embolized superselectively. RESULTS: Immediate, complete control of bleeding was achieved in 100% patients. After few hours recurrent nasal bleeding occurred in 4 (7%) patients who underwent successful reembolization. There were no severe complications after procedure. Nine patients experienced few days lasting mild headache which disappeared after medicament treatment. Five patients suffered from unaided removing facial oedema. Out of 61 patients, 56 were available for 12-month follow-up evaluation. No neurological or otolaryngological complications were certified. There was also no relapse of epistaxis. CONCLUSIONS: Selective angiographic embolization is an effective method that should be considered in the treatment of refractory epistaxis. It is safe and not traumatic for patients.

Assessment of effectiveness of endovascular treatment of common and external iliac artery stenosis/occlusion using self-expanding Jaguar SM stents.

The goal of this work was to assess the effectiveness of endovascular treatment of common and external iliac artery stenosis/occlusion classified according to TASC using a self-expanding stent Jaguar SM. The study group included 95 patients (61 men and 34 women) who underwent treatment for stenosis or occlusion of lower limb arteries at the Department of Radiology of the University Hospital in Bialystok and the Diagnostic Radiology Department of the Central Clinical Hospital of the Ministry of Interior (MSWiA) in Warsaw between 2005 and 2007. All arterial lesions were of atherosclerotic etiology. The shortest stenotic fragment was 10 mm long and the longest occluded arterial fragment did not exceed 90 mm. Morphological classification of iliac artery lesions in treated patients was performed according to TASC II classification and included 10 patients with type A, 39 cases of type B, 36 with type C and 10 patients with type D lesions. Endovascular procedure failed to restore flow in five patients with TASC type D lesions, who were later referred for surgery. One patient suffered a complication - vessel perforation during predilatation, and had a stentgraft implanted. In 95% of patients stents were expanded using a balloon after implantation. Good results were achieved in practically all patients who underwent stent implantation. Patients were subjected to follow-up clinical and imaging evaluation during next 1-24 months. Success rate of the performed procedures as well as in a 30-day observation period was 100% in case of stenosis and 80% in case of vessel occlusion. A follow-up after 12 and 24 months showed patency of treated vessels in 84% and 76% of patients, respectively.

[Sonographic diagnosis and endovascular recanalization of the internal carotid artery in a patient with carotid thromboembolism following coiling of cerebral aneurysm]. / Diagnostyka ultrasonograficzna i wewnatrznaczyniowe udroznienie tetnicy po embolizacji tetniaka mózgu powiklanej zakrzepem tetnicy szyjnej wewnetrznej.

Thromboembolism after brain aneurysm embolization involves high morbidity/mortality and its conservative treatment is still a standard policy. We report the practical utility of transcranial colour-coded Doppler sonography (TCCS) in the early diagnosis and effectiveness of prompt intravascular intervention in the treatment of this condition. A 50-year-old woman developed acute neurological deficit after intravascular re-embolization of a brain aneurysm. Severely decreased blood flow velocity in the middle cerebral artery was revealed with TCCS and angiography confirmed nearly complete occlusion of the carotid artery. After heparin administration, intravascular thrombectomy was performed at the same session with implantation of a stent. The symptoms faded away within hours and the patient recovered fully. Prompt intravascular intervention could be a valuable and efficient alternative in the treatment of thromboembolism after embolization of cerebral aneurysm. TCCS enables early differential diagnosis of this potentially devastating sequel.

Contrast-enhanced ultrasonography versus computed tomographic angiography in the monitoring of patients after endovascular repair of abdominal aortic aneurysm -- preliminary experience.

BACKGROUND: Computed tomographic angiography (CTA) is routinely used in the monitoring of patients after endovascular repair of abdominal aortic aneurysm. The aim of the study was to determine if contrast-enhanced ultrasonography (CEUS) provides equivalent results to CTA in detection of endo-leaks in patients after abdominal aortic stentgraft placement. MATERIAL AND METHODS: In a group of 7 patients (6 men and 1 woman; aged 71+/-7 years) after repair procedure, 16 CTA and 16 CEUS follow-up examinations were performed. Second-generation contrast agent (Sonovue) and low-mechanical index technique were used for ultrasonography imaging. RESULTS: Computed tomographic angiography showed seven cases of type I, five cases of type II, and no endo-leaks in four examinations. In 15 out of 16 studies, the results of CEUS were consistent with the results of CTA. In one discrepant study, type II endo-leak was detected with CEUS while CTA was negative. CONCLUSIONS: Contrast-enhanced ultrasonography and CTA examinations in patients after endovascular repair of abdominal aortic aneurysm provide comparable results. CEUS may be considered an alternative technique to CTA.

Isoenzymes of N-acetyl-beta-hexosaminidase in human pleomorphic adenoma and healthy salivary glands: a preliminary study.

BACKGROUND: Pleomorphic adenoma (PA) is a benign tumour of the salivary gland with a tendency to malignancy which creates many diagnostic problems. N-acetyl-beta-hexosaminidase (HEX) is a lysosomal exoglycosidase involved in degradation of oligosaccharide chains of glycoproteins, glycolipids and glycosaminoglycans, known as a potential tumour marker. In the majority of tissues and body fluids, HEX exists as two major isoenzymes: HEX A and HEX B. The aim of our study was to evaluate HEX A and HEX B activity in healthy and PA human salivary glands using colorimetric and isoelectrofocusing methods. METHODS: PA (n=8) and macroscopically unchanged salivary glands (n=8), served as controls, were used for the study. After preliminary preparation, isoenzymes of HEX were determined by colorimetric and isoelectrofocusing methods. RESULTS: Total activity of HEX, as well as HEX A and HEX B, in PA specimens determined by a colorimetric method was significantly higher compared with normal human salivary gland specimens. After isoelectrofocusing, in normal human salivary and PA glands, two sets of HEX isoforms were found corresponding to HEX A and HEX B. There was no significant difference in the amount of HEX A and HEX B isoforms. In PA tissue, activities of HEX isoforms in the pI ranges 1, 3b, 6 and 8 were significantly lower, and in ranges 5 and 8 significantly higher than in normal tissue. The observed significant shifts were localised mostly in HEX B activity area. CONCLUSIONS: The present data indicate that HEX activity and activity of its isoenzymes in tumour specimens is significantly and consistently elevated, and thus suggest the need for further studies on the degradation of glycoconjugates, both in healthy salivary glands and PA. It appears that HEX may be considered as a new tumour marker in these salivary gland diseases.

[Coexistence of scleroderma-like syndrome and idiopathic myelofibrosis in a 54-year-old female patient: case report]. / Wspólistnienie zespolu twardzinopodobnego i samoistnego wlóknienia szpiku u 54-letniej pacjentki: opis przypadku.

Systemic sclerosis (SSc) is characterized by immunological disturbances, vascular damage and overproduction of extracellular matrix by stimulated fibroblasts. It has been postulated that immunological reactions involved in the pathogenesis of SSc may promote the development of malignancies. Coexistence of this disease with neoplasmatic processes is relatively frequent. In our report we describe a case a 54-year-old woman with scleroderma-like syndrome, which has preceded the occurrence of idiopathic myelofibrosis by many years. Owing to multiple repeated diagnostic tests we managed to diagnose this disease at the early stage, which enabled effective therapy with remission of blood dyscrasia as well as inhibition of skin lesions and lung fibrosis.

Diagnostic cerebral angiography affects the tonus of the major cerebral arteries.

BACKGROUND: Vascular reactions after cerebral angiography have not been hitherto extensively explored due to the lack of a simple, easily available, and safe method for the measurement of cerebral circulation. We attempted to study cerebral circulation with color Doppler transcranial sonography (TCCS) in consecutive patients before and immediately after digital subtraction angiography (DSA). MATERIAL/METHODS: TCCS examination of the major cerebral arteries was carried out in 52 patients (25 females and 27 males), mean age 50.3+/-11.5 years, before and 10-20 minutes after cerebral angiography. A Toshiba Aplio SSA 770A system with a 2.5-MHz sector transducer was used. RESULTS: In general terms, there was a tendency after DSA towards a slight decrease in peak systolic blood velocity and an increase in mean and end-diastolic velocity in all the major cerebral arteries which, in turn, led to a decrease in the impedance index (pulsatility index, PI). In 19 patients, the impedance index as measured in the middle cerebral artery decreased after DSA, in 29 it did not change, while in 4 patients PI increased. Discriminant analysis showed that the factors predisposing individuals to these adverse reactions were a low score on the Glasgow Coma Scale, etiological diagnosis of intracerebral bleeding, and a high value of the impedance index prior to the procedure. CONCLUSIONS: Contrast cerebral angiography may affect the tonus of cerebral vessels. In the majority of patients it caused vasodilatation to varying degrees and in a small sub-group vasoconstriction.

Measurements of the middle cerebral artery in digital subtraction angiography and MR angiography.

BACKGROUND: The middle cerebral artery (MCA) has an individually varied anatomical type and course. Age and sex variability of MCA have not been completely defined. The aim was to define the range of normal values of widths and lengths of particular MCA segments, define age and sex variability, and compare the compatibility of MCA measurements of digital subtraction angiography (DSA) and MR angiography (MRA). MATERIAL/METHODS: The study was a retrospective evaluation of 114 examinations of cerebral vessels (88 DSA, 26 MRA). It included patients in whom the angiographic examinations did not show any pathological lesions. DSA was carried out using a routine protocol applied to examinations of cerebral arteries; MRA was performed with a 1.5 T scanner and the time of flight (TOF) method using the fast gradient echo sequence with RF spoiler- multivolume RF-FAST. The diameter measurements of the internal carotid arteries (ICA) and segments of the MCA were based on DSA and MRA; the study also included the lengths of MCA segments from the origin to the first first ramification and from the origin to the bifurcation. RESULTS: The width and length ranges of particular MCA segments in a group of healthy patients were defined by DSA and MRA. The diameters of ICA and MCA and its upper branch are age and sex dependent, being wider in men than in women and increasing with age. CONCLUSIONS: MR angiography is a fully reliable method allowing assessment of middle artery morphology, but precise evaluation of the widths of the artery and arterial branches with MRA should include the source images of the vascular sequence.

[Influence of digital subtraction cerebral angiography on blood flow in the middle cerebral artery]. / Wplyw cyfrowej angiografii subtrakcyjnej naczyn mózgowych na przeplyw krwi w tetnicy srodkowej mózgu.

UNLABELLED: The aim. Despite adhibition of new, improved enhancing agents some subjective signs during cerebral angiography are notified. This suggests that cerebral blood flow might be influenced by this procedure. The validity of transcranial color doppler sonography (TCCS) in cerebral blood flow evaluation is already proved and this method was selected for blood flow parameters estimation before and after cerebral angiography. MATERIAL AND METHODS: 33 subjects (17 female and 16 male) aged 50 +/- 13 were diagnosed by cerebral angiography. Before and immediately after angiographic examination cerebral blood flow parameters were evaluated in middle cerebral arteries by transcranial, sektor 2.5 MHz probe of Toshiba Aplio SSA 770A system. RESULTS: In comparison to pre-angiographic TCCS examination middle cerebral artery systolic velocity decreased about 3 cm/s (p<0.05). Mean and end-diastolic velocity in MCA insignificantly increased about 1 and 2 cm/s respectively (p>0.05). Impedance index values significantly decreased (Wilcoxon test, p<0.05) after angiography. CONCLUSION: Change of flow parameters in the middle cerebral artery prove increase of cerebral blood flow after diagnostic angiography.

[Doppler ultrasonography in diagnosis of internal carotid artery dissection--case report]. / Ultrasonografia dopplerowska w diagnostyce rozwarstwienia tetnicy szyjnej wewnetrznej--opis przypadku.

This study considers diagnostic problems in the case of a 52 year old patient presenting with left sided headache and Horner's syndrome. Color Doppler sonography of the internal carotid artery with transcranial duplex sonography showed decreased blood flow velocity and increased impedance of flow in the left internal carotid artery. Flow velocity in the left middle cerebral artery was moderately decreased whereas flow in the proximal segment of the anterior cerebral artery and in the posterior communicans artery was re-directed towards the left internal carotid artery. These findings indicated the need for cerebral angiography which revealed that a vast section of the distal segment of the left internal carotid artery was dissected. Pharmacological treatment with low molecule heparine brought prompt resolution of the signs and symptoms as well as normalization of the blood flow parameters, as examined with Doppler ultrasonography Color Doppler ultrasonography would appear to have high utility in the initial diagnosis of internal carotid artery dissection and the usefulness of this method in the monitoring of treatment.

The influence of the vascularisation of the follicular thyroid nodules on the proliferative activity of the follicular cells.

The enlargement of the thyroid is, in general, benign in origin and due to nodular goitre. Follicular cellular proliferation of thyroid nodules has been increasingly observed recently. With fine needle aspiration biopsy (FNAB) this is classified as a follicular tumour. These lesions present various patterns of vascularisation in ultrasound examination. The aim of the study was to establish the relation between follicular nodule vascularisation and the proliferative activity of various types of follicular cell. According to the manner of proliferation, patients were divided into groups as follows: (I). patients with hyperplastic nodules (46 cases), (II). patients with follicular adenoma (42 cases), and (III). patients with follicular cancer (9 cases). In each case B-mode sonography, Power Doppler, sonographically guided FNAB (S-FNAB), morphological examination and morphometry were performed. The proliferative activity was detected with immunohistochemical methods (PCNA, Ki 67 and MPM2) to determine the so-called "proliferative index". The study revealed increased proliferative activity in tumours of malignant origin and increased vascularisation in coexistence with increased proliferation of the follicular cells. As assessed by Power Doppler, an increased flow pattern in the centre of the nodules correlates with increased proliferative activity. The results suggest that Power Doppler examination could be helpful in selecting nodules for FNAB, especially in multinodular goitre.

Carotid artery dissection - an important complication after fine-needle aspiration biopsy.

BACKGROUND: Carotid artery dissection (CAD) is a frequent cause of ischemic stroke in patients under 40 years. It happen spontaneously or after various degree of trauma. CASE REPORT: In this report we present a case of 33 years-old woman with dissection of the common carotid and internal carotid artery after 'blind ' fine-needle aspiration biopsy of the neck lymph node. CONCLUSIONS: Fine-needle aspiration biopsy of the neck, close to carotid vessels should be always performed under control of imaging techniques.

[Transcranial color Doppler sonography (TCCD) in the diagnosis of vasospasm in the middle cerebral artery. Evaluation of TCCD diagnostic effectiveness by means of receiver operating characteristics curve (ROC) analysis]. / Przezczaszkowa ultrasonografia dopplerowska z kolorowym odwzorowaniem przeplywu w rozpoznawaniu skurczu tetnicy srodkowej mózgu. Ocena skutecznosci diagnostycznej za pomoca krzywej charakterystyki odbiornika.

Transcranial Doppler sonography is commonly used for diagnosis of cerebral vasospasm. However, the overall diagnostic performance of this method in detection of arterial narrowing has not been established. Blood velocity threshold, diagnostic for vasospasm, has been proposed for conventional, "blind" transcranial Doppler sonography (TCD). Nevertheless it cannot be used for transcranial color Doppler sonography (TCCD), because in this method the obtained blood velocities in the major cerebral arteries are higher than are in TCD. The aim of this study was to estimate the accuracy of transcranial color Doppler sonography in detection of middle cerebral artery (MCA) narrowing by means of receiver operating characteristic curve analysis (ROC). One hundred thirty four patients were studied with TCCD immediately before cerebral angiography. There were 75 men and 59 women, age range from 18 to 74 years, mean age 49 years. Of the 268 MCAs examined, 227 arteries were finally included in the construction of the ROC curve. Angiographic vasospasm was graded as none, mild (equal to or less than 25% of vessel caliber reduction--16 patients) and moderate-to-severe (more than 25% of vessel caliber reduction--29 patients). The overall diagnostic performance of transcranial color Doppler sonography in the detection of moderate-to-severe vasospasm of middle cerebral artery was found to be very high. The value of associated area under the ROC curve was 0.94. The value of this area for all vasospasms was 0.85, and this indicates good accuracy of a test. The best performing TCCD parameter for the detection of MCA narrowing was revealed to be peak-systolic velocity. The optimal trade-off between sensitivity and specificity was achieved with a peak systolic velocity of 182 cm/s. Therefore this velocity threshold is proposed as most universal for the diagnosis of vasospasm in the middle cerebral artery.

MR in neurological syndromes of connective tissue diseases.

BACKGROUND: Neurological complications in the course of SLE are mostly associated with vascular changes. An important role in their pathogenesis is played by immune mechanisms. The aim of the study was to determine the value of modern imaging techniques, with special reference to selected MR sequences (FLAIR, DWI) in the diagnosis of cerebral changes in patients with neurological symptoms of SLE. MATERIAL/METHODS: Fifty patients with neurological symptoms of SLE underwent CT and MR of CNS in routine sequences. In 12 cases EPI DWI sequences were also performed. Serum levels of antinuclear, anti-native DNA and antiphospholipid antibodies were also determined. RESULTS: The changes in CNS were detected in 48 patients in MR and in 42 patients in CT. Focal changes were observed in 29 cases, while atrophic changes were seen in the majority of subjects. In 10 cases, DWI showed changes typical for acute stroke. The extend and advancement of changes in CT and MR correlated with the severity of neurological symptoms; there was also a correlation between the changes and elevated levels of antiphospholipid antibodies. FLAIR was useful in the detection of gliosis and cortical scar, while DWI enabled us to detect acute ischaemic foci and to distinguish them from coexistent scars. CONCLUSIONS: MRI with FLAIR and DWI sequences enhances the sensitivity and specifity of neuroimaging techniques in the diagnosis of neuropsychiatric disease in SLE. There is a correlation between elevated titre of antiphospholipid antibodies and the presence of vascular changes in patients with neurological manifestations of SLE.