does Sjogren cause lesions in the brain?

[Synnove]

I have a question:
Does Sjogren's cause lesions in the brain?
The reason I am asking, I was investigated for MS do to MRI of brain showed lesions suggestion MS.  It was later ruled out.  Then I saw a neurologist who said that MS and Sjogren brain lesions looks very similar.
----- Did I misunderstand?

I still have the lesions, but it is uncertain what it is related to, I think.

[SunshineDaydream]

Here's something from John's Hopkins that says brain lesions in Sjogren's and MS are different: "Sjögren's patients may have brain lesions which can be misattributed to Multiple Sclerosis.   Ongoing studies with the Neuroimmunology Division is focusing on studying messengers called "cytokines", which are seen in Sjögren's patients, but not individuals with MS."   http://www.hopkinssjogrens.org/research/

And this says there have been brain lesions in Sjogren's patients, but no causal relationship is implied: http://www.painful-bladder.org/pdf/ch8.pdf

[Synnove]

Sunshine,
Thank you for the reply with information.  I will study this further.  ---I have so many neurological issues.  I have well established polyneuropathy.  The Small Fiber Neuropathy is what the Rheumatologist say is related to Sjogrens.

I will go back to the neurologist at the university system that looked at my brain MRI.  I have terrible feelings of tremors inside, another neurologist that treats my neuropathy says this is due to small fiber neuropathy.

It is time I bring these symptoms and different tests together and figure out what is going on.

I have printed out the information from John Hopkins.  ( I was supposed to go there once, I went to Mayo Clinic instead)

Thanks again.

[SJSman]

Hello Synnove,

Central Nervous System Vasculitis secondary to Sjogren's, a non-ANCA vasculitis, causes white-matter lesions in the brain.  In fact, if left untreated, one can accumulate tens, hundreds, or even thousands of such lesions, so it is very important to get this diagnosed and treated if you have it.

On the FLARE series of an MRI, white spots caused by CNS Vasculitis secondary to Sjogren's can appear to be very similar to the lesions caused by MS, however, they are very different in location, origin, and structure.

MS lesions tend to be found along the edge of the Corpus Callosum, and if a group of lesions are found in this particular "MS-area" of the brain, and nowhere else, then that is almost 100 Percent diagnostic of MS.  CNS vasculitis lesions are found diffusely distributed throughout the white-matter of the brain, and not just in the small MS-area.

MS lesions are cause by demyelination of the myelin sheath along the outside of nerves and some blood vessels.  Stripped of their protective sheath, liquids sometimes leak from the damaged tissue causing the white dots seen on the FLARE series of the MRI.  MS spots can heal, so a series of MRI's taken over a period of time may show dots coming and going, as old areas heal and new damage forms.

CNS Vasculitis lesions secondary to Sjogren's do not heal.  Once they are present on an MRI, they will forever be present on future MRI's.  These white-spots are formed by white cells (inflammation) clogging up the interior pathways, or other structures within the blood vessel or nerve, and therefore cutting of the blood and oxygen supply to small or large areas of tissue.  The resultant "scar" tissue, the little spots of dead brain tissue, show up as white spots on the FLARE series of an MRI.

There are several things worth mentioning.  First, everyone's brain has a white spot or two by the age of, say 50.  In an average person, the older people get, the more spots they have on their MRI.  Older people, such as age 90 or so, can have very many of these spots, and they might not have MS, CNS Vasculitis, or Dementia. 

People with very many, say a thousand spots in their brain, may be either totally normal, or else totally disabled - it is a mystery as to why this is the case, although the exact location of the tissue damage is likely the cause of the diverse outcomes.  A spot in the wrong place can cause any kind of neurological symptom, or a major disability if the damage is severe.

Another thing is - large numbers of lesions in the white-matter brain are associated with most forms of dementia.

Therefore, white spots on the MRI are not, of themselves diagnostic, of anything, and may in fact be nothing - in other words they are "non-specific" and tend to be ignored by many neurologists.  To diagnose CNS vasculitis in a patient with a history of Sjogren's, the results of a lumbar puncture are extremely useful - but that is another story.

Remember, this is a non-ANCA vasculitis.  Given the non-specific nature of most people's white spots, and a negative ANCA test, many neurologists unfamiliar with CNS vasculitis secondary to Sjogren's will never consider this diagnosis.  You need a neurologist who has seen hundreds of cases like this to make a correct diagnosis - it will take a very special neurologist to accomplish this diagnosis, and treat it. PM me if you want the name and location of one in the USA.

Finally, yes, these white spots can cause all sorts of both ordinary and/or bizarre neurological symptoms - it all depends on what tissue has been damaged in the brain.

I hope this helps.

[Synnove]

Thank you SJSman,
This is a lot of information to have a look at.--- To answer a point you mentioned,  yes, I had regular repeat MRI of brain, and they were compared.  I think the neuro was looking for new lesions.  I also did have a Lumbar Puncture, or Spinal Tap as it is also called.  This was negative for MS.  That is all I know.  I do not know what there would be in the specimen result that they might look for otherwise when it comes to CNS vasculitis.  I have had an interventional neurologist as my personal neuro, due to I got to know him, and he did my aneurysm repair.  But he did send me to specialist neuros also.  I saw an MS neuro twice.  All negative.  He sent me to a university professor neuro who specialize in neuropathy, and this doc gave me complete workup on neuropathy--- polyneuropathy and small fiber neuropathy.  the rheumatologist think this related to my Rheumatoid Arthritis.-- later diagnosed Secondary Sjogren.

My interventional neurologist also have done a few Cerebral Angiogram, monitoring the aneurysm, and also checking for CNS vasculitis.--The last one was done just last December.  No CNS Vasculitis seen here, bur the original aneurysm has began to refill where it was emboli zed by coiling 2011.  So this is bad news.  BUT  doing this angiogram, I guess it does not show toni small vessels where there could be possible vasculitis.  I was dx by rheumatologist with leukocytoclastic vasculitis, by skin biopsy,  and treated for some time with Methotrexate.

I have plans to go back and see the neurologist at the university.

I have not heard of SNS vasculitis secondary to Sjogrens.

I have a feeling there is something more present than Peripheral Neuropathy.

Thanks for your reply with information.

Synnove. 

[warmwaters]

My understanding is that you can have lesions in the brain as part of neurological inflammation. When I was being tested for Autonomic Neuropathy (which it turns out I do have), the doctor did MRI to look to see if had brain plaques.  I didn't.  If I had, he would have taken a more aggressive approach than the approach we did take.