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Lupus Central Nervous System Complications


lupus cnsNeurologic manifestations of SLE are common and vary from mild to severe. They can be difficult to diagnose and distinguish from other diseases. All portions of the nervous system may be affected, including the CNS. Definite diagnosis of CNS lupus may be difficult, as symptoms may be related to medications, other medical conditions, or individual reactions to chronic illness.

Examples of neurological manifestations include cranial or peripheral neuropathy, psychosis, coma, transverse myelitis, meningitis, cognitive impairment, mental changes, seizures, and stroke.

Potential Problems:

  • alteration in mental status, cognition, and perception
  • altered ability to perform activities of daily living and meet family responsibilities
  • potential for injury

Cranial or peripheral neuropathy occurs in 10 to 15 percent of patients; it is probably secondary to vasculitis in small arteries supplying nerves. Cerebrovascular accidents (strokes) are reported in approximately 15 percent of patients. Between 10 and 20 percent of patients experience seizures. Although cognitive impairment is believed to be very common, formal cognitive function testing may be required in order to document it.

Serious CNS involvement ranks behind only kidney disease and infection as a leading cause of death in lupus. However, the majority of SLE patients with CNS complications do not develop a life-threatening disease.

Summary of Potential Lupus CNS Complications

General CNS Lupus

  • headaches
  • confusion
  • seizures
  • psychosis
  • numbness
  • paralysis
  • coma
  • aphasia

Cranial Neuropathies

  • visual defects
  • blindness
  • nystagmus (involuntary movement of the eyeball)
  • ptosis (paralytic drooping of the eyelid)
  • papilledema (edema in the optic disk)
  • tinnitus
  • vertigo
  • facial palsy

Spine

  • transverse myelitis

Cognitive Impairment

  • confusion
  • impaired long- and short-term memory
  • difficulty in conceptualizing, abstracting, generalizing, organizing, and planning information for problem solving n difficulties in personal orientation and in dealing with the larger world
  • selective attention
  • difficulties in pattern recognition, sound discrimination and analysis, and visual-motor integration

Mental Changes

  • depression
  • anxiety
  • affective disorder
  • mood swings
  • hypomania or mania (especially with corticosteroid use)

Rare CNS Manifestations

    • myelitis
    • movement disorder

lupus nervous system

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