Neuropsychiatric manifestations in adult lupus patients are common but not always serious. They may occur early or late in the course of lupus, may be the presenting feature of lupus and can be a challenge to manage. The most common manifestations early in the disease are headache, mood disorders and anxiety, seizures, cerebrovascular disease, cognitive dysfunction, and acute confusional state. Other neuropsychiatric manifestations that may occur include movement disorders such as chorea, transverse myelitis, cranial nerve and peripheral neuropathies and myasthenia gravis.
Neuropsychiatric features may be due to inflammatory mechanisms related to lupus, thrombosis usually due to antiphospholipid antibodies, atherosclerosis or co-morbid conditions, of which infection is the most important not to misdiagnose. Being aware of the risk factors and underlying mechanisms for different neuropsychiatric manifestations will ensure prompt and appropriate investigations and treatment. Investigations may include MRI and in selected cases other forms of imaging, CSF examination, neurophysiology and cognitive function testing. Therapy may include immunosuppressants, anticoagulation, antiplatelet agents and treatment specific to the clinical presentation.
Most headaches in lupus patients are not due to lupus but the possibility of aseptic meningitis, benign intracranial hypertension, cerebral haemorrhage and venous thrombosis should be considered. Seizures may be part of the initial presentation of lupus and unless recurrent or associated with abnormalities on imaging do not require long term therapy with anticonvulsants. Cerebrovascular disease presenting as stroke is more common later in the disease, and is more often due to atherosclerosis, thrombosis or emboli than haemorrhage or vasculitis. Chorea is usually associated with anti-phospholipid antibody syndrome. Transverse myelitis may be due to inflammatory or thrombotic mechanisms and is not always associated with abnormalities on MRI scan at the time of the acute event. Prompt diagnosis and treatment is essential to reduce the risk of permanent disability.
Disclosure of Interest None Declared