What is the role of brain biopsy in the workup of CNS lupus?

Updated: May 04, 2021
  • Author: Pradeep C Bollu, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Meningeal or brain biopsy should only be considered in situations in which the benefits (e.g., preventing unnecessary immunotherapy, excluding opportunistic infections) outweigh the surgical risks. Brain biopsy is sometimes necessary when magnetic resonance imaging (MRI) findings fail to distinguish SLE cerebritis from an opportunistic infection or neoplasm, balancing the risks and benefits of biopsy against the risks and benefits of empiric therapy. Rarely, meningeal biopsy is necessary to diagnose chronic meningitis that cannot be diagnosed through conventional serology, cultures, or other methods.

Brain biopsy may demonstrate the protean findings of opportunistic infections or neoplasm, but uncomplicated SLE cerebritis typically demonstrates the small vessel vasculopathy discussed in Organic Encephalopathies, with or without an inflammatory infiltrate. Because much of clinically apparent so-called cerebritis proves to result from cardiac embolism, typical findings of acute, subacute, or chronic embolic infarction may be found.

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